SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1625399
"COMPARATIVE EFFICACY AND SAFETY OF POLARX VS ARCTIC FRONT ADVANCE PRO CRYOBALLOON SYSTEMS FOR PULMONARY VEIN ISOLATION IN ATRIAL FIBRILLATION: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS"
Provisionally accepted
Muhammad Fawad Tahir1
Muhammad Hamza Shuja2
Ramish Hannat3Fabeeha Shaheen4Amna Sayeed5
Ayesha Shaukat2Faiza Rajput2Kinza Hamid6Areeba Khan4Aymen Azan Ahmed7Syeda Asfiha Wasiq5Huda Naeem2Bakhtawar Shaikh5
Muhammad Omar Larik2
Raheel Ahmed8*
Mustafa Shehzad9Mah I Kan Changez10Muhammad Usman Haider11
Tanesh Ayyalu12- 1H.B.S Medical and Dental College, Islamabad, Pakistan
- 2dow university of health sciences, karachi, Pakistan
- 3Services Institute of Medical Sciences (SIMS), Lahore, Pakistan
- 4Jinnah Sindh Medical University, Karachi, Pakistan
- 5Karachi Medical and Dental College, Karachi, Pakistan
- 6Akhtar Saeed Medical and Dental College, Lahore, Pakistan
- 7Peshawar Medical College, Peshawar, Pakistan
- 8imperial college london, London, United Kingdom
- 9Hackensack University Medical Center, Hackensack, NJ, United States
- 10Yale University, New Haven, CT, United States
- 11Geisinger Health System, Pennsylvania, United States
- 12MedStar Heart and Vascular Institute, Baltimore, MD, United States
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Cryoballoon (CB) ablation is a well-established treatment for atrial fibrillation (AF). The Arctic Front Advance Pro™ (AFA-Pro) system, in use for over a decade, has demonstrated consistent efficacy and safety. Recently, the POLARx™, a novel CB system, has gained attention due to its advanced design and comparable clinical outcomes.We conducted a systematic review and meta-analysis of studies comparing AFA-Pro and POLARx in patients undergoing CB ablation for AF. Outcomes included procedural parameters (procedure time, ablation time, fluoroscopy time, balloon nadir temperature) and safety endpoints such as phrenic nerve palsy (PNP) and overall complication rates.There were no significant differences between POLARx and AFA in acute PVI success (OR = 0.49, P = 0.24), procedure time (MD = 4.40, P = 0.14), ablation time (SMD = 0.12, P = 0.10), fluoroscopy time (MD = 0.34, P = 0.67), freezing time and stroke rates. POLARx showed a significant advantage in balloon nadir temperature (P < 0.00001) and demonstrated longer time to isolation (TTI) in the RSPV (MD = 5.49, P = 0.05) and RIPV (MD = 4.54, P = 0.04), while TTI was similar for the LSPV and LIPV. However, POLARx was associated with a higher risk of PNP (OR = 1.87, P = 0.007).POLARx demonstrates lower balloon nadir temperature but is associated with a higher risk of phrenic nerve palsy compared to AFA-Pro. These findings provide important insights into the procedural efficiency and safety profiles of these cryoablation systems.
Keywords: Cryoballoon ablation, Atrial Fibrillation, Pulmonary vein isolation, POLARx, Arctic Front Advance
Received: 08 May 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Fawad Tahir, Hamza Shuja, Hannat, Shaheen, Sayeed, Shaukat, Rajput, Hamid, Khan, Ahmed, Wasiq, Naeem, Shaikh, Larik, Ahmed, Shehzad, I Kan Changez, Haider and Ayyalu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Raheel Ahmed, imperial college london, London, United Kingdom
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