Differences between 2 cryoballoon systems in achieving successful pulmonary vein isolation in patients with challenging anatomies.

BACKGROUND

A new technology, the POLAR cryoballoon system, was designed to enhance maneuvering and stabilizing catheter positions with a softer balloon and more deflectable sheath. These novel characteristics may help achieve successful pulmonary vein (PV) isolation in difficult cases when conventional balloons were used.

OBJECTIVE

This study aimed to investigate the differences in the lesion profiles, touch-up radiofrequency ablation (RFA) rate, and anatomical predictors of acute PV isolation between the POLAR and Arctic Front Advance Pro (AFA-Pro).

METHODS

This retrospective study included 338 consecutive patients who underwent a first cryoballoon ablation for paroxysmal atrial fibrillation at Keio University Hospital from April 2019 to September 2023. Using propensity score matching, we extracted 135 pairs treated with a POLAR or AFA-Pro, compared the procedural outcomes, and explored the anatomical predictors related to successful PV isolations.

RESULTS

In the matched cohort of 270 patients (median age 67 years [59-73], 77% male), 1535 cryoballoon applications were delivered for 1063 PVs, and touch-up RFA was performed for 84 PVs in 67 patients. The rate of touch-up RFA was significantly lower for the right inferior PV (RIPV) in the POLAR group (9.8% vs 21.6% = .013), whereas there was no significant difference for the other PVs. A lower RIPV frontal angle was linearly associated with a more favorable outcome for the POLAR group than for the AFA-Pro group (interaction = .0385).

CONCLUSION

The touch-up RFA rate for the RIPV was significantly lower in the POLAR group than in the AFA-Pro group, with a particularly pronounced difference for inferiorly oriented RIPVs.