BACKGROUND: Visually guided laser balloon ablation is known as an effective pulmonary vein (PV) isolation device. The third-generation laser balloon ablation system (X3) equipped with compliant balloon and an automated motor-driven laser output mechanism, namely RAPID mode, has been clinically proven for PV isolation. METHODS: PV isolation with X3 was performed in all the patients with paroxysmal and early-stage persistent atrial fibrillation (AF). Acute data for PV isolation and clinical outcomes including supraventricular tachyarrhythmia (SVT: AF, atrial flutter, or atrial tachycardia)-free survival rate beyond 1 year were analyzed. RESULTS: A total of 110 patients (62 ± 13 years old, 80% of paroxysmal AF) were treated with X3. RAPID mode with was utilized to achieve PV isolation in all cases. In combination with RAPID mode and spot mode laser ablation, 91.1% (380/417) of veins were isolated on the first circumferential lesion set and did not require touch-up ablation and during the index procedure 100% of attempted veins were isolated. The mean procedure time was 77.0 ± 22.7 min and LA dwell time was 61.9 ± 22.0 min. Total duration of laser application was 5.1 ± 2.3 min per vein. At 1 year, SVT-free survival rate was 93.7% in paroxysmal AF patients, and 81.1% in persistent AF patients. CONCLUSIONS: A novel continuous automatic laser balloon ablation system was proved to be safe and effective for both paroxysmal and persistent AF patients. The clinical result demonstrated that PV isolation with X3 could achieve a high SVT-free survival rate.

Cardiology Department Na Homolce Hospital Roentgenova 2 Prague 15030 Czech Republic

The Helmsley Electrophysiology Center Mount Sinai School of Medicine New York NY USA

Zobrazit více v PubMed

January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199–267. PubMed PMC

January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125–e151. doi: 10.1161/CIR.0000000000000665. PubMed DOI

Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311(7):692–699. doi: 10.1001/jama.2014.467. PubMed DOI

Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2017;19(5):775–783. PubMed

Molina-Ramos AI, Ruiz-Salas A, Medina-Palomo C, et al. Reablation in atrial fibrillation recurrence and pulmonary vein reconnection: cryoballoon versus radiofrequency as index ablation procedures. J Clin Med. 2022;11(19):5862. doi: 10.3390/jcm11195862. PubMed DOI PMC

Lennon SJ, Mannion J, Keelan E, et al. Ablation index outcome in redo persistent atrial fibrillation ablation: results of a short-term study. Cardiol Res. 2022;13(2):97–103. doi: 10.14740/cr1337. PubMed DOI PMC

Chun KRJ, Perrotta L, Bordignon S, et al. Complications in catheter ablation of atrial fibrillation in 3,000 consecutive procedures: balloon versus radiofrequency current ablation. JACC Clin Electrophysiol. 2017;3(2):154–161. doi: 10.1016/j.jacep.2016.07.002. PubMed DOI

Andrade JG, Khairy P, Macle L, et al. Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial. Circ Arrhythm Electrophysiol. 2014;7(1):69–75. doi: 10.1161/CIRCEP.113.000586. PubMed DOI

Chun JKR, Bordignon S, Chen S, et al. Current status of atrial fibrillation ablation with balloon strategy. Korean Circ J. 2019;49(11):991–1001. doi: 10.4070/kcj.2019.0226. PubMed DOI PMC

Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med. 2020;384(4):316–324. doi: 10.1056/NEJMoa2029554. PubMed DOI

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;24(12):1917–1925. doi: 10.1093/europace/euac148. PubMed DOI PMC

Reddy VY, Neuzil P, Themistoclakis S, et al. Visually-guided balloon catheter ablation of atrial fibrillation: experimental feasibility and first-in-human multicenter clinical outcome. Circulation. 2009;120(1):12–20. doi: 10.1161/CIRCULATIONAHA.108.840587. PubMed DOI

Dukkipati SR, Neuzil P, Skoda J, et al. Visual balloon-guided point-by-point ablation: reliable, reproducible, and persistent pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2010;3(3):266–273. doi: 10.1161/CIRCEP.109.933283. PubMed DOI

Dukkipati SR, Kuck KH, Neuzil P, et al. Pulmonary vein isolation using a visually guided laser balloon catheter: the first 200-patient multicenter clinical experience. Circ Arrhythm Electrophysiol. 2013;6(3):467–472. doi: 10.1161/CIRCEP.113.000431. PubMed DOI

Sediva L, Petru J, Skoda J, et al. Visually guided laser ablation: a single-centre long-term experience. Europace. 2014;16(12):1746–1751. doi: 10.1093/europace/euu168. PubMed DOI

Heeger CH, Phan HL, Meyer-Saraei R, et al. Second-generation visually guided laser balloon ablation system for pulmonary vein isolation: learning curve, safety and efficacy- the MERLIN registry. Circ J. 2019;83(12):2443–2451. doi: 10.1253/circj.CJ-19-0766. PubMed DOI

Schmidt B, Petru J, Chun KRJ, et al. Pivotal study of a novel motor-driven endoscopic ablation system. Circ Arrhythm Electrophysiol. 2021;14(3):e009544. doi: 10.1161/CIRCEP.120.009544. PubMed DOI

Fink T, Schluter M, Heeger CH, et al. Stand-alone pulmonary vein isolation versus pulmonary vein isolation with additional substrate modification as index ablation procedures in patients with persistent and long-standing persistent atrial fibrillation: the Randomized Alster-Lost-AF Trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation). Circ Arrhythm Electrophysiol. 2017;10(7):e005114. PubMed

Miyazaki S, Horie T, Hachiya H, et al. The mechanisms of recurrent atrial arrhythmias after second-generation cryoballoon ablation. Am Heart J. 2020;221:29–38. doi: 10.1016/j.ahj.2019.12.002. PubMed DOI

Verma A, Jiang C-y, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812–1822. doi: 10.1056/NEJMoa1408288. PubMed DOI

Chun JKR, Bordignon S, Last J, et al. Cryoballoon versus laserballoon: insights from the first prospective randomized balloon trial in catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2021;14(2):e009294. doi: 10.1161/CIRCEP.120.009294. PubMed DOI

Yamaguchi M, Miyazaki S, Kajiyama T, et al. Pulmonary vein isolation in patients with a left common pulmonary vein: comparison between second-generation cryoballoon and radiofrequency ablation. J Cardiol. 2019;73(4):292–298. doi: 10.1016/j.jjcc.2018.12.004. PubMed DOI

Heeger CH, Tiemeyer CM, Phan HL, et al. Rapid pulmonary vein isolation utilizing the third-generation laserballoon - The PhoeniX registry. Int J Cardiol Heart Vasc. 2020;29:100576. PubMed PMC

Bordignon S, Boehmer MC, Klostermann A, et al. Visually guided pulmonary vein isolation in patients with persistent atrial fibrillation. Europace. 2016;18(4):538–542. doi: 10.1093/europace/euv208. PubMed DOI