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The advantages and disadvantages of the novel fourth-generation cryoballoon as compared to the second-generation cryoballoon in the current short freeze strategy

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Abstract

Background

The novel fourth-generation cryoballoon (4th-CB) is characterized by a shorter-tip that potentially facilitates better time-to-isolation (TTI) monitoring. We sought to clarify the advantages and disadvantages of the 4th-CB compared to the second-generation cryoballoon (2nd-CB) in pulmonary vein isolation (PVI).

Methods

Forty-one and 49 consecutive atrial fibrillation patients underwent 2nd-CB and 4th-CB PVIs using 28-mm balloons and short freeze strategies. When effective freezing was not obtained, the CB was switched to the other CB.

Results

The rate of successful PVIs was significantly higher for 2nd-CBs than 4th-CBs (162/162[100%] vs. 178/193[92.2%] PVs, p < 0.0001). The difference was significant for lower PVs, especially right inferior PVs (RIPVs)(p = 0.005). In a total of 15 PVs in 11 patients, 4th-CBs were switched to 2nd-CBs, and 14/15(93.3%) PVs were successfully isolated. The balloon temperature tended to reach -55℃ more frequently with 2nd-CBs than 4th-CBs during RIPV ablations (15/41[36.6%] vs. 12/49[24.5%], p = 0.21). The TTI monitoring capability was significantly higher with 4th-CBs than 2nd-CBs (131/188[69.7%] vs. 83/160[51.9%] PVs, p = 0.0007). The difference was significant for right superior and left inferior PVs, but not for left superior PVs. Even if PVs requiring crossover were excluded, the total freeze duration (715±152 vs. 755±215 seconds, p = 0.31) tended to be shorter for 2nd-CBs than 4th-CBs. The incidence of phrenic nerve injury was similar for 2nd-CB and 4th-CB ablation (0/41 vs. 2/49, p = 0.12)

Conclusions

The 4th-CB’s shorter balloon tip enabled a significantly higher capability of TTI monitoring; however, it resulted in significantly lower rates of successful PVIs than the 2nd-CB, especially for the RIPVs.

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Acknowledgements

We would like to thank Mr. John Martin for his help in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Shinsuke Miyazaki, Kanae Hasegawa, Moe Mukai, Daisetsu Aoyama, Minoru Nodera, Yuichiro Shiomi, Naoto Tama, Hiroyuki Ikeda, Kentaro Ishida, Hiroyasu Uzui & Hiroshi Tada

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  1. Shinsuke Miyazaki
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  2. Kanae Hasegawa
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  3. Moe Mukai
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  6. Yuichiro Shiomi
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  11. Hiroshi Tada
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Corresponding author

Correspondence to Shinsuke Miyazaki.

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Ethics approval

The study protocol was approved by the hospital’s institutional review board. The study complied with the Declaration of Helsinki.

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All patients gave their written informed consent.

Conflict of interest

Dr. Miyazaki has received consulting fees and speaker honoraria from Medtronic and belongs to the endowed departments of Medtronic, Boston, Abbott, and Japan Lifeline.

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Miyazaki, S., Hasegawa, K., Mukai, M. et al. The advantages and disadvantages of the novel fourth-generation cryoballoon as compared to the second-generation cryoballoon in the current short freeze strategy. J Interv Card Electrophysiol 63, 143–152 (2022). https://doi.org/10.1007/s10840-021-00957-5

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  • DOI: https://doi.org/10.1007/s10840-021-00957-5

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