Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO

Abstract

Background:The novel fourth-generation cryoballoon (CB4) potentially allows for enhanced catheter maneuverability and more frequent capture of pulmonary vein (PV) potentials which can be used to monitor real-time PV isolation (PVI). The aim of our study is to compare the acute procedural endpoints between the CB4 and second-generation cryoballoon (CB2). Methods:A single-center retrospective chart review was used to examine 50 consecutive patients with drug-refractory atrial fibrillation undergoing CB4-based PVI. Procedural data and acute success of these patients were compared to 50 propensity-matched controls who underwent cryoballoon ablation procedure using CB2. Results:Procedures performed with the CB4 showed significant shorter fluoroscopy time (14.8 ± 5.5 vs 18.0 ± 6.5 minutes, P = .04), shorter procedure time (58.3 ± 15.7 vs 65.3 ± 21 minutes, P = .13), and shorter total ablation time (10.8 ± 1.5 vs 13.8 ± 1.9 minutes, P = .42). The real-time PVI visualization rate was 33.3% in the CB2 group and 74.7% in the CB4 group (P < .001). CB4 was correlated to significant increase of acute real-time recordings with regard to all the single PV (left superior PV: 58% vs 84%, P = .02; left inferior PV: 26% vs 71%, P = .001; right superior PV 29% vs 61%, P = .01; and right inferior PV 19% vs 58%, P = .002). Conclusion:The CB4 was more often able to capture real-time recordings of PV potentials and the subsequent acute PV isolation. K E Y W O R D Satrial fibrillation, catheter ablation, cryoablation, cryoballoon catheter, pulmonary vein isolation INTRODUCTIONAs a cornerstone technique, pulmonary vein isolation (PVI) is the primary target for catheter ablation in patients with drug-refractory symptomatic paroxysmal and persistent atrial fibrillation (AF). 1 Furthermore, the cryoballoon (CB) catheter is a well-described tool that has achieved good procedural results with a freedom from AF recurrence that is similar to radiofrequency ablation catheters. 2 Particularly, since 2012, the second-generation CB (CB2, Artic Front Advance, Medtronic, Inc., Minneapolis, MN, USA) has been described as a catheter with a high procedural success rate and durability of clini-cal outcomes in the treatment of patients with AF. [3][4][5][6][7] Recent technical changes were completed to improve the CB catheter in terms of maneuverability and pulmonary vein (PV) signal recordings during PVI.The resulting fourth-generation CB (CB4, Artic Front Advance PRO, Medtronic, Inc.) is characterized by a shorter tip (8-mm distal tip versus 13.5-mm tip of the traditional balloon, a 40% reduction) that can potentially facilitate better visualization of PV signals (Figure 1).The real-time visualization of PV potentials allows for a patienttailored ablation strategy. Specifically, the visualization of timeto-effect (TTE; defined as the duration of freeze until acute circumferential cellular electrical dormancy is achieved) can be 890

A comparison of acute procedural outcomes within four generations of cryoballoon catheters utilized in the real‐world multicenter experience of 1STOP

“…The description of the CB catheter ablation procedure has been previously published . In general, patients were treated with general anesthesia or conscious sedation during the procedure, and a heparin bolus was delivered at the time of the transseptal needle puncture into the left atrium.…”

“…The third‐generation CB (CB‐3; Arctic Front Advance ST) utilized a shorter distal nose‐tip on the balloon to facilitate an enhanced ability to record real‐time PV potentials and assess the time to acute PVI (denoted as either time‐to‐isolation (TTI) or time‐to‐effect . More recently, a fourth‐generation CB (CB‐4; Arctic Front Advance PRO) has been made available, which potentially enhances catheter maneuverability and ergonomics while still maintaining the shorter distal nose‐tip . To date, pairwise comparisons have been made between different versions of CBs; however, no study has yet to compare all four CBs in one complete data set.…”

“…More recently, a fourth‐generation CB (CB‐4; Arctic Front Advance PRO) has been made available, which potentially enhances catheter maneuverability and ergonomics while still maintaining the shorter distal nose‐tip . To date, pairwise comparisons have been made between different versions of CBs; however, no study has yet to compare all four CBs in one complete data set. Consequently, we examined patients that were treated for AF using the CB‐1 vs CB‐2 vs CB‐3 vs CB‐4.…”

Ergonomics in cryoballoon based catheter ablation for atrial fibrillation

“…I have read the paper by Moltrasio et al . representing the acute procedural outcomes of new generation (4 th ) cryoballoon catheter (CB4) for atrial fibrillation ablation.…”

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I have read the paper by Moltrasio et al 1 representing the acute procedural outcomes of new generation (4 th ) cryoballoon catheter (CB4) for atrial fibrillation ablation. In a small sample sized observational study, the authors reported that use of CB4 was associated with shorter fluoroscopy (P = .04), procedure (P = .13), and total ablation (P = .42) times as compared to second generation cryoballoon (CB) (CB2) group.

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