Ablation of atrial fibrillation using the fourth-generation cryoballoon Arctic Front Advance PRO

2021 ◽  
Vol 17 (1) ◽  
pp. 81-87
Author(s):  
Erik Wissner
Keyword(s):  
Atrial Fibrillation ◽  
Second Generation ◽  
Retrospective Studies ◽  
Pulmonary Veins ◽  
Thermodynamic Characteristics ◽  
The Arctic ◽  
Fourth Generation ◽  
Safety And Efficacy ◽  
Front Advance ◽  
Arctic Front

The cryoballoon (CB) is a popular ablation technology used for pulmonary vein isolation. The fourth-generation CB, Arctic Front Advance PRO features a 40% shorter distal tip but retains the internal design from its second-generation predecessor. The Arctic Front Advance PRO and the second-generation CB demonstrated similar thermodynamic characteristics in a computational model. Several observational and retrospective studies established the acute safety and efficacy of the Arctic Front Advance PRO. Real-time electrical isolation was observed in 75–85% of pulmonary veins targeted with the Arctic Front Advance PRO resulting in shorter fluoroscopy and procedure times.

Experience in cryobaloon atrial fibrillation ablation – Polish operators perspective

2019 ◽  
Vol 2 (51) ◽  
pp. 4-7
Author(s):  
Agnieszka Wojdyła-Hordyńska ◽  
Jakub Baran ◽  
Paweł Derejko
Keyword(s):  
Atrial Fibrillation ◽  
Second Generation ◽  
Pulmonary Veins ◽  
Atrial Fibrillation Ablation ◽  
Cryoballoon Ablation ◽  
Years Of Experience ◽  
Technology Changes ◽  
Front Advance ◽  
Arctic Front ◽  
Over 40 Years

The first use of cryoablation in the treatment of arrhythmia has already been described over 40 years ago [1]. Since the introduction of cryoballoon in pulmonary veins isolation in atrial fibrillation treatment, the method has started to attract a lot of interest. Over 350,000 procedures around the word were carried out only by 2018 [2]. Recently, there have been several new publications on the results of second-generation cryoballoon ablation [2, 3, 4]. In view of technology changes, and to summarize years of experience in the treatment of atrial fibrillation, the first Cryousers conference was organized, and held in 2018 in Poland. During this meeting a survey was conducted, obtaining data on the practice of atrial fibrillation treatment in 38 Polish electrophysiological centers performing cryoablation of atrial fibrillation using both balloons, Arctic Front Advance, Medtronic Inc., Minneapolis MN, and radiofrequency point by point ablation. Around 3,745 cryoballoon procedures were performed in the surveyed centers during the year preceding the survey. The survey concerned practical issues related to the qualification and preparation of patients for the procedure, its course, and the results of pulmonary veins isolation in Poland.

scholarly journals Smart Touch Radiofrequency Catheter Ablation versus Cryoballoon Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

2020 ◽  
Vol 8 (B) ◽  
pp. 563-568
Author(s):  
Walid Shehata Hassan ◽  
Sherief Hamed Zaky ◽  
Khaled Hussein Mohamed ◽  
Moataz Mohammed Ibrahim
Keyword(s):  
Atrial Fibrillation ◽  
Complication Rate ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
Medicine Department ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
Front Advance

AIM: Evaluation of the safety and efficacy of pulmonary veins isolation in patients with paroxysmal atrial fibrillation (AF) using two new different technologies, cryoballoon (CB) ablation and radiofrequency ablation with contact force (CF)-sensing catheters. METHODS: Prospective single-center evaluation, carried out from January 2016 to June 2018 in Critical Care Medicine Department – Cairo University, comparing CF radiofrequency (Thermocool® SmartTouch, Biosense Webster, Inc.) (CF group) with CB ablation (Arctic Front Advance 28 mm CB, Medtronic, Inc.) (CB group), in regards to procedural safety and efficacy, as well as recurrence at 12 months. Overall, 50 consecutive patients were enrolled (25 in each group). RESULTS: The characteristics of patients of both the groups were similar (46.9 ± 11.2 years, the proportion of women 36%, mean documented AF duration 3 ± 2.3 years, mean CHA2DS2-VASc score 1.4 ± 1.3, and mean HAS-BLED 1.4 ± 0.6). Duration of the procedure was significantly lower in the CB group (171.7 ± 15.24 vs. 199.3 ± 18.94 min, p = 0.002), with a longer duration of fluoroscopy and X-ray exposure in the CB group than the CF group but statistically non-significant difference (58.60 ± 11.57 vs. 48.7 ± 13.86 min and 6273 ± 4934 cGy cm² vs. 6853 ± 5069 cGy cm², p = 0.1 and p = 0.2, respectively). Overall complication rate was similar in both groups: 2 (8%) in each group. At 12 months, AF recurrence occurred in 7 patients (28%) in the CF group and in 9 patients (36%) in the CB group (log rank p = 0.682). CONCLUSION: Pulmonary vein isolation using CF-guided RF and second-generation CB leads to comparable single-procedure arrhythmia-free survival at up to 12 months with similar overall complication rate.

scholarly journals Cryoballoon atrial fibrillation ablation: Single-center safety and efficacy data using a novel cryoballoon technology compared to a historical balloon platform.

2020 ◽  
Author(s):  
Adriano Kochi ◽  
Massimo Moltrasio ◽  
Fabrizio Tundo ◽  
Sfefania Isabella Riva ◽  
Ciro Ascione ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Similar Efficacy ◽  
The Novel ◽  
Single Center ◽  
Historical Cohort ◽  
Safety And Efficacy ◽  
Procedural Time ◽  
Front Advance ◽  
First Time

Introduction: Catheter ablation is superior to drugs regarding atrial fibrillation (AF) recurrence, symptoms improvement, and mortality reduction in heart failure. POLARx™ is a novel cryoballoon, with technical improvements seeking to improve outcomes. So far, its clinical evidence is restricted to a case report. Methods: To compare the POLARx™ cryoballoon procedural safety and efficacy to the already established Arctic Front Advance PRO™ (AFAP) in a single-center cohort study, consecutive patients undergoing AF cryoablation with the POLARx™ were enrolled. Data were prospectively gathered. POLARx™ patients were compared to a historical cohort of patients submitted to AF cryoablation with the AFAP. Results: Seventy patients were analyzed, 20 in POLARx™, and 50 in the AFAP group. They all underwent first-time pulmonary vein isolation, 77% were male, 94% had paroxysmal AF, median age was 62.5 years, median CHA2DS2-VASc 1, left-atrium size 34ml/m², and 65% were receiving anticoagulation. The primary end-point, all pulmonary veins isolation, was 100% in both groups. The complication rate was similar (0% POLARx™ vs. 5.7% AFAP, p=0.39). The median total procedural time was longer in the POLARx™ group (90min vs. 60min, p<0.001), but the overall time-to-isolation (TTI) (44.8sec vs. 39sec, p=0.253) and ablation time (15min vs. 13.7min, p=0.122) was similar between POLARx™ and AFAP groups, respectively. Despite equal TTI, the POLARx™ had a lower minimal temperature reached (-57ºC vs -47ºC, p<0.001). Conclusion: The novel POLARx™ cryoballoon had similar efficacy and safety compared to the AFAP. It was also associated with longer procedural times, similar TTI, and lower minimum temperature reached.

scholarly journals Safety and Efficacy Using the Second-Generation Cryoballoon in Patients With Atrial Fibrillation and a Common Ostium of Inferior Pulmonary Veins

2021 ◽  
Vol 8 ◽  
Author(s):  
Hai-yang Xie ◽  
Xiao-gang Guo ◽  
Jian-du Yang ◽  
Jia-hui Li ◽  
Yan-qiao Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Second Generation ◽  
Anatomic Variation ◽  
Pulmonary Veins ◽  
Consecutive Series ◽  
Safety And Efficacy ◽  
Inferior Pulmonary Vein ◽  
The Right

Background: Common ostium of inferior pulmonary veins (COIPV) is a kind of pulmonary vein variation. The safety and efficacy of COIPV isolation using the second-generation cryoballoon (CB) ablation remain unknown.Methods: A total of 10 patients with COIPV from a consecutive series of 1,751 patients with atrial fibrillation (AF) were included. Pulmonary vein isolation (PVI) was performed using the second-generation CB.Results: The prevalence of a COIPV was 0.57% in this study. PVI was achieved in all pulmonary veins (PVs) without the need for a touch-up. A segmental freeze strategy was applied for each inferior PV, respectively. The mean number of freeze cycles of inferior PVs was 1.4 ± 0.5 for the left inferior pulmonary vein (LIPV), and 2.0 ± 0.9 for the right inferior pulmonary vein (RIPV). Pulmonary vein potential (PVP) of RIPV could not be monitored in real-time in three cases. Eight of 10 patients (80%) were free from atrial arrhythmias without the use of antiarrhythmic drugs during a follow-up period of 23.6 ± 12.9 months. No procedure-related complications occurred in any of the 10 patients.Conclusions: Common ostium of inferior pulmonary veins is a rare but challenging PV variant. PVI with this unusual anatomic variation using the second-generation 28-mm CB is effective and safe.

scholarly journals Initial experience and follow up on the PolarX cryoablation system compared to the established Arctic Front cryoablation system in PVI ablations

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Riesinger ◽  
S R Popal ◽  
J E Bohnen ◽  
J Siebermair ◽  
E Pesch ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Safety Data ◽  
The Arctic ◽  
Complication Rates ◽  
3D Mapping ◽  
Safety Outcome ◽  
Scar Area ◽  
Front Advance ◽  
Arctic Front

Abstract Introduction Pulmonary vein isolation (PVI) with cryoablation was shown to be comparable to radiofrequency ablation (RF) in terms of safety and outcome for patients with atrial fibrillation (AF), so that both techniques are recommended equally by the current guidelines. A new cryoablation system PolarX® was introduced in 2020. We analysed the first patients, who underwent ablation with the new system with respect to procedural and safety outcome and evaluated the freedom from arrhythmia occurrence in the first 6 months compared to patients treated with the established Arctic Front Advance® cryoablation system. Methods We included the consecutive 44 patients who underwent cryoablation with the new PolarX® cryoablation system (28mm) and 24 patients who underwent cryoablation with the established Arctic Front Advance® cryoablation system (28mm) for paroxysmal AF. We retrospectively analysed baseline characteristics, procedural- and safety data. In 5 patients of each group an additional high-density 3D-mapping was performed, evaluating the scar-area after cryoablation in both groups (figure 1A+B). After 6 months the freedom of AF (by 7d-Holter-ECG) was evaluated in both groups. Results Baseline, procedural characteristics and results are listed in table 1. Mean total procedure duration (“door-to-door-time”) was significantly shorter in the PolarX group compared to the Arctic-Front group (136±34min vs. 163±43min; p&lt;0.05). Number of freezes required to achieve isolation of all pulmonary veins (PVs) and cumulative freezing time was comparable in both groups. Minimal achieved temperatures were significantly lower in the PolarX group vs. ArcticFront group. The scar-area analyzed by 3D-mapping post ablation did not differ in the two groups. Complication rates as well as clinical outcome (freedom from AF) were low and did not differ in the Kaplan-Meier analysis (table 1; figure 1C). Conclusion Based on these initial results, cryoablation with the PolarX cryoballoon seems to be comparably effective and safe, with a significantly shorter procedure time and significantly lower achieved temperatures. Nevertheless, future controlled trials with a longer follow-up period will be necessary to evaluate long-term effectiveness. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Feasibility and safety of left atrial posterior wall isolation with a new Cryoballoon technology in patients with persistent atrial fibrillation

2021 ◽  
Author(s):  
Antonio Bisignani ◽  
Luigi Pannone ◽  
Vincenzo Miraglia ◽  
Juan Sieira ◽  
Saverio Iacopino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
The Arctic ◽  
Cryoballoon Ablation ◽  
The Novel ◽  
Front Advance ◽  
Arctic Front ◽  
Left Atrial Posterior

Introduction: Left atrial posterior wall isolation (LAPWI) is often performed in addition to pulmonary vein isolation (PVI) to improve outcome in patients with persistent atrial fibrillation (AF). In this setting, LAPWI + PVI using cryoballoon ablation had comparable results with radiofrequency ablation (RFA). The aim of the study is to evaluate the feasibility and safety of a new cryoballoon ablation system in PVI + LAPWI isolation, comparing it with the historical platform. Methods: The study was a prospective, non-randomized, single center study. Forty consecutive patients, undergoing PVI + LAPWI with the novel POLARx™, were compared to 40 consecutive patients who underwent the same procedure with the established Arctic Front Advance PRO™. Results: Acute isolation was achieved in all PVs in both groups and LAPWI was achieved in 38 patients (95%) in the POLARx group and in 36 patients (90%) in Arctic Front group. Procedural outcomes were similar between the two groups, except for lower temperatures during cryoapplications in the POLARx group, for both PVI and LAPWI. The complication rate was low and similar between groups. Conclusion: LAPWI+PVI with the novel POLARx™ Cryoballoon is feasible and safe; the results are comparable with the Arctic Front Advance PRO™ system.

New cryoballoon atrial fibrillation ablation, is it the time for changes?

2018 ◽  
Vol 2 (47) ◽  
pp. 16-21
Author(s):  
Grzegorz Hordyński ◽  
Agnieszka Wojdyła-Hordyńska
Keyword(s):  
Atrial Fibrillation ◽  
Best Practice ◽  
First Generation ◽  
Second Generation ◽  
Atrial Fibrillation Ablation ◽  
Arctic Front ◽  
Procedural Recommendations

Since the release of the second-generation cryoballoon (CB2; Arctic Front AdvanceTM, Medtronic Inc) and its modifications with improved cooling characteristics, the technique, dosing, and complication profile is significantly different from that of the first-generation cryoballoon. Several reports of CB2 procedural recommendations have been presented. Hereby, the literature summary was performed and the technical and procedural study based regimen delivered. The best practice overview presents large centers contemporary techniques for safer and more effective outcomes and perhaps new approved recommendations for atrial fibrillation treatment.

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