A new circular mapping-guided approach for endoscopic laser balloon pulmonary vein isolation. (1st September 2015)

• Record Type: Journal Article
• Authors: Gal, Pim; Smit, Jaap Jan J.; Adiyaman, Ahmet; Ramdat Misier, Anand R.; Delnoy, Peter Paul H.M.; Elvan, Arif
• Is Part Of: IJC heart & vasculature. Volume 8(2015)
• Page Start: 68
• Page End: 72
• Publication Date: 2015-09-01
• Subjects: Atrial fibrillation -- Ablation -- Pulmonary vein isolation -- Laser balloon -- CMC; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2015.05.005
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is performed with the endoscopically assisted laser balloon ablation system (EAS). We hypothesized that placement of a circular mapping catheter (CMC) in the pulmonary vein (PV) distal to the laser balloon during ablation is feasible and safe. Methods: Out of 58 included patients, 37 underwent mapping-guided EAS PVI, with the CMC inside the PV during laser ablation, and 21 patients underwent standard EAS PVI, with the CMC outside the PV during laser ablation. Results: Mean age was 56 years and 81% had paroxysmal AF. In the mapping-guided ablation group, 91% of PVs were isolated with the CMC in the PV during EAS ablation, isolation was completed in 9% of PVs after the CMC was removed from the PV. After passing a learning curve in 18 patients, a significant drop in unsuccessfully isolated PVs was observed in the mapping guided EAS PVI group (15% to 4%, P = 0.020). No major complications were seen in the mapping-guided EAS PVI group. However, in the standard EAS PVI group, laser ablation was complicated by a temporary phrenic nerve palsy in 1 patient. After a median follow-up of 16.7 months, there was no statistical difference in AF free survival among treatment groups (mapping-guided: 56% vs. 52%, P = 0.875). Conclusion: Mapping guided EAS PVI with a distal CMC in the PV during laser ablation is feasible and seems safe as the standard EAS PVI approach.