Observational studyEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2024
Incidence of phrenic nerve injury during pulmonary vein isolation using different cryoballoons: data from a large prospective ablation registry.
Observational study in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparative efficacy and safety of POLARx versus Arctic front advance pro cryoballoon systems for pulmonary vein isolation in atrial fibrillation: an updated systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2025Pooled it
- Disentangling the Hemodynamic Effects of A-Wave Loss and Cardiac Output Reduction in Atrial Fibrillation.Annals of biomedical engineering · 2026Article
- Single-shot ablation for AF: Real-world procedural and one-year outcomes with the newly adopted PulseSelect PFA compared with cryoballoon from the 1STOP project.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Procedural outcomes of single versus double transeptal access for ablation of atrial fibrillation: Data from the NCDR Afib ablation registry.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Transient ST-Segment Elevation During Cryoablation of the Right Inferior Pulmonary Vein in Atrial Fibrillation.JACC. Case reports · 2026Article
- Volume Rendering-Based Phrenic Nerve/Pericardiophrenic Bundle Identification Using Cardiac Computed Tomography.JACC. Case reports · 2025Article
- Spatiotemporal tissue temperature during cryoablation using different balloons.Heart rhythm O2 · 2025Article
- Impact of cryoballoon size adjustability on procedural and clinical outcomes.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Differences between 2 cryoballoon systems in achieving successful pulmonary vein isolation in patients with challenging anatomies.Heart rhythm O2 · 2025Article
- Phrenic nerve reconstruction after combined resection in malignant tumors: a narrative review.Mediastinum (Hong Kong, China) · 2025Review
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Authors and funding
25 authors.
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No grant is acknowledged in the PubMed record.
Abstract
aimsPhrenic nerve injury (PNI) is the most common complication during cryoballoon ablation. Currently, two cryoballoon systems are available, yet the difference is unclear. We sought to compare the acute procedural efficacy and safety of the two cryoballoons.
methodsThis prospective observational study consisted of 2,555 consecutive atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) using either conventional (Arctic Front Advance) (AFA-CB) or novel cryoballoons (POLARx) (POLARx-CB) at 19 centers between January 2022 and October 2023.
resultsAmong 2,555 patients (68.8 ± 10.9 years, 1,740 men, paroxysmal AF[PAF] 1,670 patients), PVIs were performed by the AFA-CB and POLARx-CB in 1,358 and 1,197 patients, respectively. Touch-up ablation was required in 299(11.7%) patients. The touch-up rate was significantly lower for POLARx-CB than AFA-CB (9.5% vs. 13.6%, p = 0.002), especially for right inferior PVs (RIPVs). The touch-up rate was significantly lower for PAF than non-PAF (8.8% vs. 17.2%, P < 0.001) and was similar between the two cryoballoons in non-PAF patients. Right PNI occurred in 64(2.5%) patients and 22(0.9%) were symptomatic. It occurred during the right superior PV (RSPV) ablation in 39(1.5%) patients. The incidence was significantly higher for POLARx-CB than AFA-CB (3.8% vs. 1.3%, P < 0.001) as was the incidence of symptomatic PNI (1.7% vs. 0.1%, P < 0.001). The difference was significant during RSPV (2.5% vs. 0.7%, P < 0.001) but not RIPV ablation. The PNI recovered more quickly for the AFA-CB than POLARx-CB.
conclusionsOur study demonstrated a significantly higher incidence of right PNI and lower touch-up rate for the POLARx-CB than AFA-CB in the real-world clinical practice.
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