Evaluation of different ablation strategies verifying the optimal overlap ratio in point-by-point laser balloon ablation for patients with atrial fibrillation

• Main Authors: Takahiko Nagase, MD, Ruiko Seki, MD, So Asano, MD, Hiroshi Fukunaga, MD, Kazuhiro Terashima, MD, Kei Mabuchi, MD, Kanki Inoue, MD, Kohei Tanizaki, MD, Nobuo Iguchi, MD, Junichi Nitta, MD, Mitsuaki Isobe, MD
• Format: Article
• Language: English
• Published: Elsevier 2021-08-01
• Series: Heart Rhythm O2
• Subjects: Atrial fibrillation; Optimal energy; Optimal overlap ratio; Point-by-point laser balloon ablation; Pulmonary vein isolation
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666501821001161
• ISSN: 2666-5018

Background: Optimal overlap ratio remains unclear in point-by-point laser balloon (LB) ablation. Objective: This study sought to determine the optimal overlap strategy with target energies on the acute and chronic outcomes in LB pulmonary vein (PV) isolation (PVI). Methods: Consecutive 38 patients (148 PVs) with atrial fibrillation underwent the first-generation LB PVI with the following protocols based on the overlap ratios for each PV anterior/posterior wall: 50%/50% (13 patients [49 PVs], group A), 50%/25% (15 patients [60 PVs], group B), and 25%/25% (10 patients [39 PVs], group C). High energies (240–255 J: 12 W / 20 seconds, 8.5 W / 30 seconds), moderate energies (200–210 J: 10 W / 20 seconds, 7 W / 30 seconds), and low-to-moderate energies (low, 165–170 J: 5.5 W / 30 seconds, 8.5 W / 20 seconds) were targeted for left PV anterior walls, right PV anterior walls, and bilateral PV posterior walls, respectively. First-pass PVI, the other procedure-related data, and atrial tachyarrhythmia recurrences were analyzed. Results: First-pass PVI rate per PV was higher in group A (94%) than in group B (88%) and group C (62%) (P < .001). All PVs were finally isolated. First-pass time, total LB PVI time, complications, and atrial tachyarrhythmia recurrences during a mean follow-up of 11 ± 5 months did not differ between the groups. A few residual gaps after first-pass LB ablations were found for PV anterior walls even in group A and group B. Conclusion: Sufficiently overlapped LB ablation promises a high rate of first-pass PVI without adverse outcomes. High energy could be required for PV anterior walls.