Wide Circumferential vs Individual Pulmonary Vein Isolation
Circumferential versus Individual Laserballoon PVI
Introduction The endoscopic ablation system (EAS) allows for effective pulmonary vein isolation (PVI). The feasibility of wide circumferential as compared to individual PVI using the EAS has not been formally assessed.
Methods Patients with paroxysmal or short-persistent atrial fibrillation were assigned to individual PVI (group A) or wide circumferential PVI (group B). In group B, circumferential PVI was attempted only if the ipsilateral inferior PV was visualized while the ablation system targeted the superior PV and vice versa. Otherwise, individual PVI was performed.
Results A total of 38 patients were enrolled (Group A: 20 patients, age 61 ± 7 years, LA-diameter 43 ± 5 mm; Group B: 18 patients, age 62 ± 10 years, LA-diameter 43 ± 4 mm). In group A, 20/20 (100%) right superior (RSPV) and inferior (RIPV) PVs, 18/19 (95%) left superior (LSPV) and inferior (LIPV) PVs, and 1/1 (100%) left common ostium (LCPV) were successfully isolated. First-pass success rate was 95%, 85%, 68%, and 95% for the RSPV, RIPV, LSPV, and LIPV, respectively. Touch-up radiofrequency ablation was required in 1/19 (5%) LSPV and LIPV. In group B, an attempt at circumferential PVI was feasible in 2/18 (11%) septal PVs and successful on first pass. Lateral circumferential PVI was attempted and successful on first-pass in 7/13 (54%) LSPVs and LIPVs and 1/5 (20%) LCPVs.
Conclusions Using the EAS in patients with AF, separate isolation of individual PVs rather than wide circumferential PVI should be the preferred ablation strategy.
Complete electrical pulmonary vein isolation (PVI) represents the established procedural endpoint of catheter ablation of atrial fibrillation (AF). The most widely used technique utilizes conventional radiofrequency (RF) energy ablation in a point-by-point fashion in combination with a 3-dimensional electroanatomical mapping system. However, inherent limitations of conventional ablation have led to the development of alternative energy sources and catheter designs. The endoscopic ablation system (EAS, CardioFocus, Inc., Marlborough, MA, USA) incorporates a compliant balloon and a laser source that allow deployment of point-by-point lesions under direct visual guidance. Data on the feasibility, safety, and clinical outcome of EAS-based PVI have recently been published. The current prospective study sought to compare wide circumferential to separate isolation of individual PVs using the EAS and assess acute procedural success, safety, and clinical outcome.
Abstract and Introduction
Abstract
Circumferential versus Individual Laserballoon PVI
Introduction The endoscopic ablation system (EAS) allows for effective pulmonary vein isolation (PVI). The feasibility of wide circumferential as compared to individual PVI using the EAS has not been formally assessed.
Methods Patients with paroxysmal or short-persistent atrial fibrillation were assigned to individual PVI (group A) or wide circumferential PVI (group B). In group B, circumferential PVI was attempted only if the ipsilateral inferior PV was visualized while the ablation system targeted the superior PV and vice versa. Otherwise, individual PVI was performed.
Results A total of 38 patients were enrolled (Group A: 20 patients, age 61 ± 7 years, LA-diameter 43 ± 5 mm; Group B: 18 patients, age 62 ± 10 years, LA-diameter 43 ± 4 mm). In group A, 20/20 (100%) right superior (RSPV) and inferior (RIPV) PVs, 18/19 (95%) left superior (LSPV) and inferior (LIPV) PVs, and 1/1 (100%) left common ostium (LCPV) were successfully isolated. First-pass success rate was 95%, 85%, 68%, and 95% for the RSPV, RIPV, LSPV, and LIPV, respectively. Touch-up radiofrequency ablation was required in 1/19 (5%) LSPV and LIPV. In group B, an attempt at circumferential PVI was feasible in 2/18 (11%) septal PVs and successful on first pass. Lateral circumferential PVI was attempted and successful on first-pass in 7/13 (54%) LSPVs and LIPVs and 1/5 (20%) LCPVs.
Conclusions Using the EAS in patients with AF, separate isolation of individual PVs rather than wide circumferential PVI should be the preferred ablation strategy.
Introduction
Complete electrical pulmonary vein isolation (PVI) represents the established procedural endpoint of catheter ablation of atrial fibrillation (AF). The most widely used technique utilizes conventional radiofrequency (RF) energy ablation in a point-by-point fashion in combination with a 3-dimensional electroanatomical mapping system. However, inherent limitations of conventional ablation have led to the development of alternative energy sources and catheter designs. The endoscopic ablation system (EAS, CardioFocus, Inc., Marlborough, MA, USA) incorporates a compliant balloon and a laser source that allow deployment of point-by-point lesions under direct visual guidance. Data on the feasibility, safety, and clinical outcome of EAS-based PVI have recently been published. The current prospective study sought to compare wide circumferential to separate isolation of individual PVs using the EAS and assess acute procedural success, safety, and clinical outcome.
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