A tale of two balloons: technical and procedural difference between cryoballoon systems

Tomaiko-Clark, Emrie; Bai, Rong; Khokhar, Mateen; Su, Wilber

doi:10.1097/hco.0000000000000942

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…For instance, the recently launched POLARx cryoballoon (Boston Scientific, Marlborough, MA) is made of a proprietary thermoplastic material, which allows the balloon more compliance when engaging with PV. 19 The intra-balloon pressure is continuously monitored and adjusted at a constant low level (2.5-7.5 psi depending on size of balloon) by an equipped pressure sensor. Therefore, the intra-balloon pressure, balloon shape, size and stiffness of POLARx balloon remain stable after freezing starts in contrast to the Medtronic's cryoballoon.…”

Section: Discussionmentioning

confidence: 99%

“…Innovative designs have emerged to possibly prevent cryoballoons from dislodgement during freezing. For instance, the recently launched POLARx cryoballoon (Boston Scientific, Marlborough, MA) is made of a proprietary thermoplastic material, which allows the balloon more compliance when engaging with PV 19 . The intra‐balloon pressure is continuously monitored and adjusted at a constant low level (2.5–7.5 psi depending on size of balloon) by an equipped pressure sensor.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation–An underappreciated frequent cause of incomplete isolation

Liao,

Tomaiko‐Clark,

Martinez

et al. 2023

Pacing Clinical Electrophis

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BackgroundCryoballoon ablation for atrial fibrillation (AF) requires adequate contact between the pulmonary vein (PV) antrum and cryoballoon. The surge of intraballoon pressure during the initial phase of ablation may change the balloon's shape and compliance, resulting in balloon dislodgement and loss of PV occlusion. Without continuous monitoring, this phenomenon is often undetected but can be associated with incomplete PV isolation (PVI).MethodsPrimary cryoablation of AF was performed in 15 patients. PV occlusion status pre‐ and post‐freezing were analyzed with intracardiac echocardiography (ICE) and dielectric imaging‐based occlusion tool (DIOT) to calculate the incidence of expansion dislodgement of cryoballoon.ResultsA total of 105 cryoablation applications were performed on 57 veins, including three common ostiums of left pulmonary veins. In the evaluation of PV occlusion, both modalities reported consistent results in 86.7% of the assessments. Despite complete PV occlusion before ablation, peri‐balloon leak after initiation of freezing was detected by ICE in 5/22 (22.7%) applications and by DIOT in 8/25 (32%) applications.ConclusionIncidence of expansion dislodgement of the cryoballoon was detected in one‐fourth to one‐third of cryoablation applications depending on the imaging modality used, which was clinically frequent and significant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation–An underappreciated frequent cause of incomplete isolation

Liao,

Tomaiko‐Clark,

Martinez

et al. 2023

Pacing Clinical Electrophis

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“…In contrast, The POLARsheath™ (BosSci) does not have a step-up between the dilator and sheath, and has a 155°angle of deflection with the goal of affording more maneuverability particularly for occlusion of the often challenging right inferior pulmonary vein, or other difficult anatomies. 4 The PolarX™ thermoplastic balloon itself is designed to maintain a constant pressure, stiffness and shape throughout inflation and ablation. As well, the balloon is available in a 28 and 31 mm size compared to the 28 mm size of the Arctic Front™ (Medtronic) although the present study primarily examined the 28 mm sized balloon with a 50 patient extension arm examining the interchangeable balloon size (28 and 31 mm).…”

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confidence: 99%

“…The mapping catheter in theory can be withdrawn without compromising balloon stability. 4 Thus, the overarching question for the present analysis was whether the differences in design of the PolarX™ balloon and ablation system afford procedural ease or better efficacy compared to previously available technology.…”

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confidence: 99%

Frozen too: Adopt the new or let it go?

Dhande,

Jain

2024

Cardiovasc electrophysiol

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Pulmonary vein isolation (PVI) has been established as the mainstay of interventional management of atrial fibrillation, as has the utility of cryoablation as one of two standard thermal techniques for achieving PVI. 1 The efficacy of cryoballoon ablation is known to be comparable to radiofrequency ablation, however novel technologies within the realm of contemporary cryoablation have yet to be explored. 2,3 Ellenbogen et al. report the results of an international multicenter, open-label, prospective, single-arm study on the safety and performance of PolarX™ (BosSci), a new cryoballoon system for treatment of paroxysmal atrial fibrillation. 3 Compared to the current standard of care Medtronic cryoablation system, the Boston Scientific system differs in its design. The FlexCath™

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“…In the article by Tomaiko-Clark et al article [1] in the January 2022 issue, an error was made in regard to the design specifications of the Boston Scientific POLARx balloon. The POLARx balloon is pressurized to a constant 2.5 psi through inflation and ablation.…”

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confidence: 99%