Background: The importance of a wider circumferential isolation of the pulmonary veins (PV), which includes a large portion of the left atrial posterior wall (LAPW), has been suggested in several studies. However, the extended isolation area using a larger inflated visually guided laser balloon (VGLB) ablation remains to be elucidated.
Methods: Seventy-eight patients with atrial fibrillation (AF) who underwent VGLB ablation were enrolled in this prospective study. An electroanatomic map of the left atrium was obtained before and after PV isolation (PVI) using a conventional-sized VGLB. The isolation areas were extended by the largest-sized VGLB ablation and remapped in the same manner. After the ablation, isolation areas were calculated with CARTO-3 system. The one-year atrial arrhythmia (Ata) recurrence was assessed. RESULTS: The largest-sized VGLB ablation yielded statistically greater areas of isolation in left-sided PV antrum (PVA) (11.5 ± 2.3 cm vs. 15.9 ± 3.5 cm, P < .001) and right-sided PVA (14.2 ± 3.3 cm vs. 20.6 ± 4.4 cm, P < .001) than the conventional-sized VGLB. Further, non-ablated LAPW (12.3 ± 4.4 cm vs. 7.8 ± 3.9 cm, P < .001) was significantly reduced after largest-sized VGLB ablation, compared to the conventional-sized VGLB ablation. The one-year Ata freedom was 83.7% in patients with paroxysmal AF and 96.4% in those with persistent AF.
Conclusion: The largest-sized VGLB ablation technique can create a significantly wider isolation area of PVA and debulk a large amount of LAPW than the conventional-sized VGLB ablation. The one-year outcome was similarly high in paroxysmal and persistent AF.
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Article Synopsis
- The study explored whether fully circumferential lesions are necessary for achieving pulmonary vein isolation (PVI) during laser balloon ablation, especially considering potential complications like stenosis.
- In a trial with 51 patients, researchers found that 39% of PVs achieved early PVIs with significantly better success in lower PVs compared to upper PVs (60.1% vs. 17.6%).
- The results suggest that additional research is needed to understand the energy requirements for lower PVs to prevent chronic narrowing, as energy delivery was less for lower PVs yet stenosis rates were similar for both upper and lower PVs after 6 months.
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