Tahir Muhammad Fawad, Shuja Muhammad Hamza, Hannat Ramish, Shaheen Fabeeha, Sayeed Amna, Shaukat Ayesha, Rajput Faiza, Zahoor Muhammad Ahmed, Hamid Kinza, Khan Areeba, Ahmed Aymen Azan, Wasiq Syeda Asfiha, Naeem Huda, Shaikh Bakhtawar, Larik Muhammad Omar, Ahmed Raheel, Shehzad Mustafa, Changez Mah I Kan, Haider Muhammad Usman, Ayyalu Tanesh
Department of Medicine, H.B.S Medical and Dental College, Islamabad, Pakistan.
Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
Front Cardiovasc Med. 2025 Aug 18;12:1625399. doi: 10.3389/fcvm.2025.1625399. eCollection 2025.
BACKGROUND: Cryoballoon (CB) ablation is a well-established treatment for atrial fibrillation (AF). The Arctic Front Advance Pro™ (AFA-Pro) system, in use for over a decade, has demonstrated consistent efficacy and safety. Recently, the POLARx™, a novel CB system, has gained attention due to its advanced design and comparable clinical outcomes. METHODS: We conducted a systematic review and meta-analysis of studies comparing AFA-Pro and POLARx in patients undergoing CB ablation for AF. Outcomes included procedural parameters (procedure time, ablation time, fluoroscopy time, balloon nadir temperature) and safety endpoints such as phrenic nerve palsy (PNP) and Stroke rates. RESULTS: There were no significant differences between POLARx and AFA in acute PVI success (OR = 0.49, P = 0.24), procedure time (MD = 4.40, P = 0.14), ablation time (SMD = 0.12, P = 0.10), fluoroscopy time (MD = 0.34, P = 0.67), freezing time and stroke rates. POLARx showed a significant advantage in balloon nadir temperature (P < 0.00001) and demonstrated longer time to isolation (TTI) in the RSPV (MD = 5.49, P = 0.05) and RIPV (MD = 4.54, P = 0.04), while TTI was similar for the LSPV and LIPV. However, POLARx was associated with a higher risk of PNP (OR = 1.87, P = 0.007). CONCLUSION: POLARx demonstrates lower balloon nadir temperature but is associated with a higher risk of phrenic nerve palsy compared to AFA-Pro. These findings provide important insights into the procedural efficiency and safety profiles of these cryoablation systems. SYSTEMATIC REVIEW REGISTRATION: identifier CRD42024588371.
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