Novel vs established cryoballoon ablation system for atrial fibrillation: A systematic review and meta-analysis

Recently, a novel cryoballoon ablation system (POLARx) for the treatment of atrial fibrillation has been introduced.

We aimed at systematically reviewing the efficacy and safety of the POLARx compared with the ArcticFront system.

Structured systematic database search for articles published between 2021 and 2024 reporting the efficacy and/or safety of the POLARx system for atrial fibrillation ablation. The co-primary endpoints were the long-term efficacy and safety of the POLARx system.

Of the 24 studies with 5364 patients (weighted mean age 62.4 years) included, 15 compared the POLARx system (1746 patients) with the ArcticFront system (2282 patients). Despite significantly lower temperatures at isolation (POLARx -46.3 °C, ArcticFront -31.6 °C, P < .01) and nadir temperatures (POLARx -56.5 °C, ArcticFront -47.8 °C, P < .01), the POLARx system did not show a better acute (98.9% and 99.2% successfully ablated patients and 99.5% and 99.8% successfully ablated pulmonary veins in the POLARx and ArcticFront groups, respectively) or long-term (after a weighted mean follow-up of 12.6 months, the success rate was 69.5% with POLARx and 60.2% with ArcticFront, P = .98) efficacy. While most complications were similar between the POLARx and ArcticFront groups, the incidence of phrenic nerve palsies in the pooled cohorts (all POLARx vs all ArcticFront control patients) differed (2.7% vs 1.6% in the POLARx vs ArcticFront groups; odds ratio 1.79, 95% confidence interval 1.14-2.83, P = .01).

The novel POLARx system provided similar efficiency and acute/long-term efficacy but showed a higher incidence of phrenic nerve palsies compared with the ArcticFront system.