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The real-time assessment of pulmonary vein isolation and safety of cryoballoon 3 versus cryoballoon 2 for atrial fibrillation: A systemic review and meta-analysis

Objectives: Cryoballoon ablation (CBA) has become a routine treatment option for paroxysmal atrial fibrillation (PAF). The third-generation CB (CB3) also known as “Arctic Front Advance ST” (CB-ST) was designed with a shorter distal tip. There have been several publications describing the characteristics of the CB3 system. We, therefore, undertook this systemic review and meta-analysis to compare the efficacy and safety of CB3 versus the second-generation CB (CB2) also known as “Arctic Front Advance.” Methods and Results: We performed a search on PubMed, Embase, and Web of Science database for studies published by August 2016 using the keywords “CB3,” “short-tip cryoballoon,” “Arctic Front Advance ST,” “CB3,” “cryoablation,” and “CBA.” Six studies with a total of 1625 patients were identified. There were 351 patients underwent CBA with CB3, and 1274 underwent CBA with CB2. Overall analyses indicated that there was a significant improvement in the real-time pulmonary vein isolation (RT-PVI) recording rate with CB3 compared to CB2 (odds ratio of 3.08, P < 0.00001). The procedure time (PT) was shorter for CB3 (weighted mean difference [WMD], 95% confidence interval CI: −10.27, [ − 19.2, −1.35], P = 0.02), while fluoroscopic time (WMD, 95% CI: 0.71, [ − 1.27, 2.68], P = 0.48) was not statistically different between the two groups. Conclusions: In this meta-analysis involving 1625 patients, the CB3 system decreased PT, enhanced RT-PVI recording rate while maintaining a similar safety profile.