Visually guided pulmonary vein isolation in patients with persistent atrial fibrillation.

Aims: The role of balloon catheters in patients with persistent forms of atrial fibrillation (AF) remains ill defined. We therefore sought to assess the safety and efficacy of a laser balloon (LB)-guided pulmonary vein isolation (PVI) in consecutive all-comers with persistent AF.

Methods And Results: All patients undergoing an LB-guided PVI procedure for persistent AF between January 2011 and December 2012 were matched to patients undergoing circumferential PVI using irrigated radiofrequency (RF) current ablation for date of procedure, age, gender, AF duration, left atrial (LA) size, and left ventricular ejection fraction. The primary endpoint was freedom from AF between 90 and 365 days post-ablation after a single procedure. Eighty patients (mean age 66 ± 9; 71% male) with a median (Q1-Q3) AF episode duration of 2 (1-3) months underwent successful PVI in the two groups. The primary endpoint of 1-year single procedure AF/atrial tachycardia (AT) recurrences was reached by 11/40 (27.5%) patients in the LB group and in 9/40 (22.5%) patients in the RF group (P = 0.87). During a mean follow-up of 517 ± 170 days, 13 (32.5%) and 16 (40%) patients in the LB and RF groups, respectively, experienced AF/AT recurrences (P = 0.64). Procedural complications occurred in one patient in the LB group and in six patients in the RF group.

Conclusion: A subset of patients with drug-refractory persistent AF of short duration benefit from pure PVI without additional substrate modification. A LB-based strategy showed similar outcomes as an irrigated RF-guided circumferential PVI and may be considered an alternative option for the index ablation.