GOING BEYOND THE CONVENTIONAL POLARx: Setting a new standard in cryoablation

Going beyond the conventional

POLARx™: Setting a new standard in cryoablation

Clinical Evidence 

Numerous studies have demonstrated the safety and efficacy of the POLARx™ Cryoablation System in the treatment of paroxysmal atrial fibrillation. It has been studied and is in use in multiple countries across the globe.

  • In several comparative studies POLARx Cryoablation System demonstrated a similar safety and efficacy profile to a competitive technology12,14-19,21,22
  • POLARx showed different cryoablation metrics with lower nadir temperatures, shorter time to -40°C and longer thaw times but similar acute outcomes12-15,17,21-23,25
  • Real-Time TTI vizualization is recorded more often with POLARx12,12,15,22,25
     

Find out more
 

Read the POLARx Clinical Compendium

Find publication summaries and key take aways from the latest cryoablation studies.

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Read the Clinical Compendium

Key POLARx performance

FROzEN-AF US IDE Clinical Trial

In a global, prospective, single-arm study, researchers evaluated the safety and effectiveness of the POLARx Cryoablation System (PLX) for treatment of symptomatic, drug refractory, recurrent, paroxysmal atrial fibrillation (PAF). At 12 months, data revealed a 96.0%*** freedom from primary safety events for POLARx and 100% for POLARx FIT (extension arm). Freedom from atrial arrhythmias was 79.9% for POLARx and 82.0% for POLARx FIT1. The findings also point to an increase in Grade 4 occlusions and in successful single-shot therapy with POLARx FIT at 31 mm cryoballoon expansion.²

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Global

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44 Centers

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Prospective

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Single-arm

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325 Patients
50 FIT patients (extension arm²)

Objective:

Evaluate the safety and effectiveness of the Boston Scientific POLARx Cryoablation System for treatment of symptomatic, drug refractory, recurrent, paroxysmal atrial fibrillation (PAF).

50 patients were treated to collect safety and effectiveness data on the POLARx FIT expandable (28 mm and 31 mm) cryoballoon (CB) catheter.

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Acute procedural results

Procedural ​
Characteristic​
FROzEN-AF​
(28 mm balloon)​
POLARx FIT Extension Arm​
(28 mm / 31 mm balloon)​
General Anesthesia (%)​78.5%​100%​
Conscious Sedation/MAC (%)​21.5%​ -
Procedure Time (min)​91 ± 41 min​
101 ± 59 min​
LA Dwell Time (min)​59 ± 33 min​51 ± 22 min​
Fluoroscopy Time (min:sec)​12:52 ± 11:12 min​7:10 ± 11:18 min​
Grade 3-4 Occlusion* (%)​95.9% (69.9% - Grade 4)​97.7% (66.4% / 77.6% - Grade 4)
Single Shot Success* (%)​55.9%​35.3% / 62.1%​

Mean ± SD
*Only ablations with duration >60 sec included in ablation counts​

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Chronic safety and efficacy

FROZEN AF (POLARx)​¹
(n=325)

12-MONTH EFFICACY

polarx-clinicalevidence-79.9percentage

Freedom from atrial arrhythmias

12-MONTH SAFETY

polarx-clinicalevidence-96.0percentage

Freedom from primary event

Extended POLARx FIT arm1
(n=50)​

12-MONTH EFFICACY

polarx-clinicalevidence-82.0percentage

Freedom from atrial arrhythmias

12-MONTH SAFETY

polarx-clinicalevidence-100percentage

Freedom from primary event**

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  • 12-month data on POLARx™ FIT showed low arrhythmia recurrence and high freedom from primary safety events, after a high rate of Grade 3 or 4 occlusions achieved.¹
  • The choice of balloon sizes** with POLARx FIT may assist in overcoming challenges related to variability in patient PV size and geometry with the 31 mm CB achieving high-grade 3-4 vein occlusion, lowering the LA dwell and fluoroscopy times and increasing the single-shot isolation rate.

**(31 and 28 mm)

Key POLARx performance

Proof-of-Concept clinical trial

In a single-center, single-arm observational investigation, researchers assessed the acute performance of the POLARx FIT novel-size, adjustable, second-generation cryoballoon system in paroxysmal AF ablation procedures. 

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Italy

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Single-center

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Single-arm

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24 FIT consecutive patients

Objective:

Assess the acute performance of the POLARx FIT novel-size, adjustable, second-generation cryoballoon system in paroxysmal AF (PAF) ablation procedures. 

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Acute procedural results

Procedural Characteristics

Overall (n=24)

Overall procedural time (min), median (IQR)

90 (60–110)

Overall fluoroscopy time (min), median (IQR)

15.5 (12–22.3)

Anatomical variants

Right common pulmonary trunks, n (%)

Left common pulmonary trunks, n (%)

Additional PV branches, n (%)

 

2 (8.3)

1 (4.2)

3 (12.5)

Number of applications needing the 31 mm size, n (%)

64 (51.6)

Minimal reached temperatures

LSPV (°C), median (IQR)

LIPV (°C), median (IQR)

RSPV (°C), median (IQR)

RIPV (°C), median (IQR)

 

-52.0 (−54.5–−50.5)

-49.0 (−52.0–−48.0)

-50.0 (−54.0–−45.5)

-50.0 (−57.0–−48.0)

In-hospital AF recurrences, n (%)

2 (8.3)

Periprocedural complications

Groin hematoma, n (%)

Pericardial effusion, n (%)

Cardiac tamponade, n (%)

Phrenic nerve palsy, n (%)

Thromboembolic complications, n (%)

 

1 (4.2)

0 (0)

0 (0)

0 (0)

0 (0)

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  • The use of the dual-size feature has helped to reach an easier PVI in various clinical scenarios.
  • The new generation POLARx FIT showed comparable easy maneuverability as POLARx, with an overall high acute success rate and low periprocedural complication rates.
  • POLARx FIT may show similar procedure and fluoroscopy times in the presence of standard PV anatomy but offers significant intraprocedural flexibility to the operator. 
  • The increased antral occlusion capability potentially reduces phrenic nerve injury.

Key POLARx performance

POLAR ICE multicenter study

In a prospective, non-randomized study conducted from 2020–2023 in multiple experienced European centers, researchers using the POLARx Cryoablation System for pulmonary vein isolation found the device to be effective, safe and efficient.³'⁴'⁵

***Updated analysis with corrected data.

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EU

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19 Centers

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Prospective

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Single-arm

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399 Patients

Objective:

Post-market clinical follow-up study to evaluate the safety and effectiveness of the POLARx Cryoablation Balloon for pulmonary vein isolation (PVI) to treat paroxysmal atrial fibrillation (PAF) using real-world data.

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Acute procedural results

TTI, Biophysics, and efficacy³

tti biophysics efficacy
tti-biophysics-efficacy
Biophysical parameters and single shot successTTI <60s
(n=852)
TTI ≥60s
(n=282)
No TTI
(n=776)
p-value
Time to -40°C (s)30.6 ± 7.4*​34.2 ± 10.735.0 ± 15.3p<0.001
Nadir Temperature (°C)-58.3 ± 5.8-56.6 ± 5.9-54.1 ± 6.8p<0.001
Thaw to °C (s)21.1 ± 6.719.3 ± 5.5​17.6 ± 6.7p<0.001
Occlusion Grade (4)89%77%63%p<0.001
Occlusion Grade (3)11%22%29%​
Single Shot Rate95%82%60%p<0.001

Data reported when available. Not all ablations reported full data, results are mean + SD or percentage.
*Significantly less than the other 2 groups.

Procedural characteristics⁴

Procedural characteristics⁴ 
Mean procedure time68.2 min
Mean left atrial dwell time46.6 min
Mean fluoroscopy time15.6 min

Performance and biophyscial characteristics⁴

Performance and biophysical characteristics⁴ 
Acute pulmonary vein isolation96.80%
Grade 3-4 occlusion98.20%
Single-shot success71.20%
Mean cryoablation per PV1.5
Mean nadir temp-56.3°C
Mean time to isolation50 sec
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Chronic safety and efficacy

Safety​⁵

polarx-clinicalevidence-4.6percentage

Primary safety event rate

polarx-clinicalevidence-4.6percentage

Major advers events No patient suffered from atrial esophageal fistula or pulmonary vein stenosis

12-month efficacy⁵

polarx-clinicalevidence-83.5percentage

Arrhythmia recurrence free rate

polarx-clinicalevidence-100percentage

AF
recurrence free rate


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  • In the POLAR ICE real-world registry there was a low safety event rate (4.6%).⁵
  • Biophysical data suggest that good occlusion may allow for faster freeze and lower nadir temperatures, resulting in longer thaw times.³
  • The one-year arrhythmia recurrence free rates were 83.5%, with an AF recurrence free rate of 88.1%.⁵
  • Lower nadir temperatures and a longer thawing time were acute predictors of long-term clinical success.⁵

Key POLARx performance

ANTARCTICA observational study

In a multicenter prospective assessment of the POLARx system's efficacy and safety for PVI in an early-adopter setting of acute efficacy and safety, researchers found that use of POLARx resulted in a high rate of real-time pulmonary vein isolation (PVI) visualization and durable lesion creation. Following a short 25-patient learning curve, experienced operators also incurred significantly fewer adverse safety events.⁶

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DE, IT

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6 Centers

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Prospective

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Single-arm

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317 PLX patients

Objective:

Assess the procedural efficacy, mid-term outcome, safety and characteristics of the novel POLARx CB for PVI.

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Acute procedural results

Performance and biophysical characteristics⁶
Acute pulmonary vein isolation99.70%
Real-time PVI visualization71.90%
Minimum CB temperature−57.9±7°C
Precedure time92±41 min
Fluoro time15±10 min
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Chronic results

polarx-86.1-percent

Freedom from
recurrence

at 226 ± 115 days

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  • First multi-center study reporting on the acute efficacy, mid-term outcome and safety of POLARx-based PVI.
  • High rate of real-time PVI visualization.
  • The rate of serious adverse events was 6.0% which was significantly reduced after a learning curve of 25 cases (9.3% vs. 3.0%, P=0.018).
  • The rate of recurrence-free survival after mean of > 6 months short-term follow-up was 86.1%.

Key POLARx performance

Other POLARx studies

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Multi-centerSingle-Center
Spera, et al, 2022
Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation
Anic, et al 2021¹¹
Acute safety, efficacy, and advantages of a novel cryoballoon ablation system for pulmonary vein isolation in patients with paroxysmal atrial fibrillation: initial clinical experience
Fassini, et al., 2022
Novel cryoballoon technology for a successful pulmonary vein isolation: acute outcome and follow up from a large multicenter Italian clinical setting
Schiavone, M. et al 202427
Early Clinical Outcomes and Advantages of a Novel-Size Adjustable Second-Generation Cryoballoon: A Proof-of-Concept Study.
Iacopino, et al., 2022
Key characteristics for effective acute pulmonary vein isolation when using a novel cryoballoon technology: insights from the CHARISMA registry
 
Martin, et al., 2022¹⁰
Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: long‑term outcomes in a multicentre clinical study
 
polarx-recentstudies

POLARx Comparative performance

Prospective ICE AGE 1 Study

In a 1-year follow-up study comparing 103 consecutive patients with paroxysmal or persistent AF who underwent PVI with POLARx (PLX) and 102 consecutive patients previously treated with Arctic Front Advance Pro™ (AFA Pro), POLARx demonstrated comparable safety and efficacy with lower cryoballoon nadir temperatures and improved rates of real-time visualization of PVI.¹²

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Germany

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Single-center

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Prospective

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PLX vs AFA Pro

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103 PLX patients
102 AFA patients

Objective:

Evaluate the efficacy, safety, and 1-year clinical outcomes of the POLARx CB compared to the Arctic Front Advance Pro CB (AFA).

 

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Acute procedural results¹²

Procedural characteristicsPLXAFA PROp-value
Mean minimal cryoballoon temp-56.1 ± 8.3°C-46.9 ± 10.1°C< 0.0001 
Real-time visualization of PVI71% of PVs46% of PVs< 0.001 
Procedure time54.5 ± 17.1 min59.4 ± 18.6 min0.0509
Periprocedural Major or Minor complicationsNo difference
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Chronic efficacy¹²


12-month efficacy

POLARx

polarx-clinicalevidence-78.9percentage

Arctic Front Advance Pro

polarx-clinicalevidence-72.2percentage


Freedom of AF or atrial tachycardia

See key outcomes


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  • POLARx and Arctic Front showed similar safety, efficacy, and recurrence-free survival rates at 1 year.
  • A higher rate of real-time electrical PV recordings and significantly lower balloon temperatures were observed using the POLARx.

POLARx Comparative performance

UK comparative study

A large United Kingdom multicenter study of 1,688 AF patients compared the POLARx Cryoablation System (PLX) to Arctic Front Advance™ (AFA) and found comparable safety and efficacy between the systems. The POLARx cohort of 844 patients experienced a low rate of procedural complications (0.8%) with no reported phrenic nerve palsy.¹³

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UK

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12 Centers

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Prospective

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PLX vs AFA

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844 PLX patients
844 AFA patients

Objective:

Compare POLARx and Arctic Front in terms of safety, procedural metrics, and efficacy in a UK large-scale multi-center study.

 

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Acute procedural results

Procedural characteristicsPLXAFA 
Procedure time78.6 ± 38.179.4 ± 25.8P=0.55
Phrenic nerve palsy0%0.10%P =1
Immediate or 30-day complicationsNo difference

See key outcomes

Nadir cryoballoon temp−54.6 ± 7.6°C
time to −40°C34.1 ± 13.7 s
time to isolation 49.8 ± 33.2 s
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  • Successful PVI was achieved with 1677 (99.3%) patients with 97.2% (n = 1641) performed as day case procedures with a complication rate of <1%.
  • Cryoablation metrics are different between the 2 systems
  • Time to reach −40°C [odds ratio (OR) 1.34; P < 0.001] and nadir temperature (OR 1.24; P < 0.001) were independent predictors for PVI achievement.

POLARx Comparative performance

Propensity Score-Matched Comparison

In a propensity score-matched comparison (covarying in age, gender, CHA2DS2VASc and left atrial dilation) between POLARx (PLX) and Arctic Front Advance Pro™ (AFA), POLARx demonstrated significantly lower procedure time and greater visualization of time-to-isolation.¹⁴

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EU

icon-hospital

3 Centers

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PLX vs AFA Pro

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30 PLX patients
30 AFA patients

Objective:

Compare the procedural efficacy and biophysical parameters of POLARx and AFA-Pro as well as the 1-year outcomes.

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Acute procedural results14

VariablesPLXAFA Prop-value
Procedure duration, minutes60.50 ± 14.2373.43 ± 13.260.001
Fluoroscopy duration, minutes12.83 ± 6.0317.23 ± 7.170.01
Contrast used, mL62.17 ± 7.8460.17 ± 8.030.9
Number of occlusion1.09 ± 0.31.19 ± 0.50.6
Time to -40ºC, seconds30.43 ± 12.5347.96 ± 16.91< 0.001
Nadir temperature, ºC-58.13 ± 6.26-49.63 ± 6.19< 0.001
Real time isolation101 (84%)84 (70%)0.009
Isolation time, seconds34.47 ± 21.2334.18 ± 26.790.9
Isolation temperature, ºC-35.5 ± 13.36-29.58 ± 11.270.002
Thaw time to 0ºC, seconds19.31 ± 7.910.0 ± 4.13< 0.001

See key outcomes

Acute procedural complicationsPLXAFA Prop-value
Transient right-sided phrenic nerve palsy3.0%3.0%1.000
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  • POLARx cryoablation system showed similar efficacy in vein occlusion, isolation and safety profile vs. Arctic Front cryoablation system.
  • Procedure time, fluoroscopy time, and cumulative freeze duration were significantly lower with POLARx cryoablation system.
  • POLARx showed a lower nadir temperature, faster time to -40°C, lower isolation temperature and longer thaw time.
  • There was no significant difference in isolation time between the two groups but electrical activity visualization enabling real time isolation was higher in POLARx than  Arctic Front.

POLARx Comparative performance

Other comparative studies

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Multi-centerSingle-Center
Yap, et al., 2022¹⁵
Comparison of the 1‑year clinical outcome of a novel cryoballoon to an established cryoballoon
Badertscher et al., 2023²⁰
Efficacy and safety of pulmonary vein isolation with pulsed field ablation vs. novel cryoballoon ablation system for atrial fibrillation
Knecht, et al., 2022¹⁵
Efficacy and safety of a novel cryoballoon ablation system: multicentre comparison of 1-year outcome
Imnadze, et al., 2022²¹
Two competing cryoballoon technologies for single shot pulmonary vein isolation: first experiences with the novel system
Honarbakhsh, et al., 2022¹⁷
POLARx Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation
Tilz, et al., 2021²²
Novel Cryoballoon Ablation System for Single Shot Pulmonary Vein Isolation – The Prospective ICE-AGE-X Study
Guckel, et al., 2022¹⁸
Impact of pulmonary vein variant anatomy and cross‑sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single‑shot guided pulmonary vein isolation¹⁸
Creta, et al., 2021²³
First experience of POLARx™ versus Arctic Front Advance™: An early technology comparison
Yap, et al., 2021¹⁹
Comparison of procedural efficacy and biophysical parameters between two competing cryoballoon technologies for pulmonary vein isolation: Insights from an initial multicenter experience
Kochi et al., 2021²⁴
Cryoballoon atrial fibrillation ablation: Single-center safety and efficacy data using a novel cryoballoon technology compared to a historical balloon platform
polarx-recentstudies

POLARx meta-analyses

Updated systematic review and meta-analysis

A systematic review and meta-analysis, including a total of 8 studies with 1146 patients from 11 European centers confirms similar acute outcomes for POLARx (PLX) and Arctic Front Advance Pro™ (AFA Pro). This updated review, following an earlier publication in 2021, provides new safety data on minimal esophageal temperature and thromboembolic events.²⁵

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EU

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11 Centers

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8 Studies*

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317 PLX patients 
819 AFA Pro patients

Objective:

The goal of this updated comprehensive meta- analysis was to compare differences in acute outcome between POLARx and AFA-Pro in patients with AF undergoing PVI.

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Acute procedural results25

 
  • No differences in acute PV isolation, procedure & fluoroscopy & ablation time, minimal esophageal temperature, risk of phrenic nerve palsy or thromboembolic events.
  • Balloon nadir temperatures were lower for POLARx in all PVs.
  • Higher rate of TTI recording in the inferior PVs with POLARx.
* mbase, MEDLINE, Web of Science, Cochrane, and Google Scholar databases were searched until 12/01/2022 for studies comparing PLX  vs. AFA in PVI patients

Other meta-analyses

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Multi-center 
Assaf, Yap et al²⁶ 
Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: A systematic review and meta‐analysis
 
polarx-recentstudies

 

 

References

1.Ellenbogen KA et al, One-year outcomes of pulmonary vein isolation with a novel cryoballoon: Primary results of the FROZEN AF trial. J Cardiovasc Electrophysiol. 2024 Apr;35(4):832-842. doi: 10.1111/jce.16220. Epub 2024 Mar 6. PMID: 38448797.    

2. Su et al. Clinial Application of a Novel 31mm Cryoballoon for Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: Procedural Data from the FIT arm of FROzEN-AF. HRS 2023

3. Martin et al., Biophysical parameters and time to isolation of pulmonary veins with a novel cryoballoon: results of POLAR ICE study, EP Europace, Volume 24, Issue Supplement_1, May 2022, euac053.078
(https://doi.org/10.1093/europace/euac053.078)

4. Martin CA, Tilz RRR, Anic A, et al. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study. J Cardiovasc Electrophysiol. 2023 Apr;34(4):833-840. Epub 2023 Feb 23. PMID: 36786515.
(https://doi.org/10.1111/jce.15861)

5. Luik A, Anic A, Asmundis C, et al. Long-term success rates of a stable, low pressure cryoballoon for the treatment of paroxysmal atrial fibrillation: Results of the prospective, international, multicenter POLAR-ICE Study. Presented at: 2023 ESC Congress, Aug. 25-28, 2023; Amsterdam, Netherlands.

6. Heeger CH, Pott A, Sohns C, et al. Novel cryoballoon ablation system for pulmonary vein isolation: multicenter assessment of efficacy and safety-ANTARCTICA study. Europace. 2022 Dec 9;24(12):1917-25
(https://doi.org/10.1093/europace/euac148)

7. Spera F et al. Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation. Front. Cardiovasc. Med. 9:985182. 2022
(https://doi.org/10.3389/fcvm.2022.985182)

8. Fassini, et al., Novel cryoballoon technology for a successful pulmonary vein isolation: acute outcome and follow up from a large multicenter Italian clinical setting, Europace 2022,
(https://doi.org/10.1093/europace/euac053.217)

9. Iacopino, et al., Key characteristics for effective acute pulmonary vein isolation when using a novel cryoballoon technology: insights from the CHARISMA registry, J Interv Cardiovasc Electrophysiol. 2022,
(https://doi.org/10.1007/s10840-021-01063-2)

10. Martin A, et al., Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: long‑term outcomes in a multicentre clinical study, J Interv Cardiovasc Electrophysiol. 2022,
(https://doi.org/10.1007/s10840-022-01200-5)

11. Anic, et al., Acute safety, efficacy, and advantages of a novel cryoballoon ablation system for pulmonary vein isolation in patients with paroxysmal atrial fibrillation: initial clinical experience, Europace 2021, (https://doi.org/10.1093/europace/euab018)

12. Heeger C-H, Popescu SS, Inderhees T. et al. Novel or established cryoballoon ablation system for pulmonary vein isolation: the prospective ICE-AGE-1 study. Europace. 2023 Aug 2;25(9):euad248.
(https://doi.org/10.1093/europace/euad248)

13. Honarbakhsh S et al., Atrial fibrillation cryoablation is an effective day case treatment: the UK PolarX vs. Arctic Front Advance experience. EP Europace, Volume 25, Issue 11, November 2023, euad286, 
(https://doi.org/10.1093/europace/euad286)

14. Mojica J, Lipartiti F, Al Housari M, et al. Procedural safety and efficacy for pulmonary vein isolation with the novel POLARx™ Cryoablation System: A propensity score matched comparison with the Arctic Front™ Cryoballoon in the setting of paroxysmal atrial fibrillation. J Atr Fibrillation. 2021 Jun 30;14(1):20200455.
(https://doi.org/10.4022/jafib.20200455)

15. Yap, et al., Comparison of the 1‑year clinical outcome of a novel cryoballoon to an established cryoballoon, J Interv Cardiovasc Electrophysiol. 2022
(https://doi.org/10.1007/s10840-022-01262-5)

16. Knecht, et al., Efficacy and safety of a novel cryoballoon ablation system: multicentre comparison of 1-year outcome, Europace 2022, 
(https://doi.org/10.1093/europace/euac094)

17. Honarbakhsh, et al., POLARx Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation, Europace 2022
(https://doi.org/10.1093/europace/euac100)

18. Guckel, et al., Impact of pulmonary vein variant anatomy and cross‑sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single‑shot guided pulmonary vein isolation, J Cardiovasc Electrophysiol. 2022
(https://doi.org/10.1007/s10840-022-01279-w)

19. Yap, et al., Comparison of procedural efficacy and biophysical parameters between two competing cryoballoon technologies for pulmonary vein isolation: Insights from an initial multicenter experience, J Cardiovasc Electrophysiol. 2021,
(https://doi.org/10.1111/jce.14915)

20. Badertscher et al., Efficacy and safety of pulmonary vein isolation with pulsed field ablation vs. novel cryoballoon ablation system for atrial fibrillation, Europace (2023) 25, 1–8. 2023 Dec 6;25(12):euad329.
(https://doi.org/10.1093/europace/euad329)

21. Imnadze, et al., Two competing cryoballoon technologies for single shot pulmonary vein isolation: first experiences with the novel system, Rev. Cardiovasc. Med. 2022
(http://doi.org/10.31083/j.rcm2304118)

22. Tilz, et al., Novel Cryoballoon Ablation System for Single Shot Pulmonary Vein Isolation – The Prospective ICE-AGE-X Study, Circ J. 2021,
(https://doi.org/10.1253/circj.cj-21-0094)

23. Creta, et al., First experience of POLARx™ versus Arctic Front Advance™: An early technology comparison,  J Cardiovasc Electrophysiol. 2021,
(https://doi.org/10.1111/jce.14951)

24. Kochi et al, Cryoballoon atrial fibrillation ablation: Single-center safety and efficacy data using a novel cryoballoon technology compared to a historical balloon platform, J Cardiovasc Electrophysiol. Feb 2021
(https://doi.org/10.1111/jce.14930)

25. Assaf A, Rohit E. Bhagwandien, Tamas Szili-Torok, Sing-Chien Yap. Comparison of the acute outcome of two cryoballoon technologies for pulmonary vein isolation: An updated systematic review and meta-analysis, IJC Heart & Vasculature 42 2022,
(https://doi.org/10.1016/j.ijcha.2022.101115)

26. Assaf A, Rohit E. Bhagwandien, Tamas Szili-Torok, Sing-Chien Yap. Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: A systematic review and meta‐analysis, J Cardiovasc Electrophysiol. 2021,
(https://doi.org/10.1111/jce.15182)

27.  Schiavone, M.; Fassini, G.; Moltrasio, M.; Majocchi, B.; Tundo, F.; Casati, F.; Tondo, C. Early Clinical Outcomes and Advantages of a Novel-Size Adjustable Second-Generation Cryoballoon: A Proof-of-Concept Study. J. Clin. Med. 2024, 13, 1259.
(https://www.mdpi.com/2077-0383/13/5/1259)

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