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. 2021 Nov;32(11):2923-2932.
doi: 10.1111/jce.15245. Epub 2021 Sep 23.

Single-sweep pulmonary vein isolation using the new third-generation laser balloon-Evolution in ablation style using endoscopic ablation system

Shota Tohoku  1 , Stefano Bordignon  1 , Shaojie Chen  1   2 , Simone Zanchi  1 , Lorenzo Bianchini  1 , Luca Trolese  3 , Felix Operhalski  4 , Lukas Urbanek  1 , K R Julian Chun  1   2 , Boris Schmidt  1   4
Affiliations

Single-sweep pulmonary vein isolation using the new third-generation laser balloon-Evolution in ablation style using endoscopic ablation system

Shota Tohoku et al. J Cardiovasc Electrophysiol. 2021 Nov.

Abstract

Background: The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The novel X3 EAS is now equipped with a contiguous circumferential ablation mode (RAPID mode).

Aim: To determine the feasibility of single-shot fashioned ablation using X3.

Methods: Consecutive patients who underwent AF ablation using X3 were enrolled. We assessed the acute procedural data focusing on "Single-sweep PVI" defined as successful PVI with a single RAPID mode energy application, and on "first-pass isolation" defined as successful PVI after initial circular lesion set.

Results: One hundred AF patients (56% male, age: 68 ± 10 years, 66% paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were isolated with X3. Single-sweep PVI and first-pass-isolation were achieved in 214 PVs (56%) and in 362 PVs (95%), respectively. Single-sweep PVI rates varied across PVs with higher rates at the superior PVs (61.2% vs. inferior PVs: 49.5%, p = .0239) and at PVs with maximal ostial diameter <24 mm (57.6% vs. >24 mm: 36.8%, p = .0151). The mean total procedure and fluoroscopy times were 43.0 ± 10 and 4.0 ± 2 min, respectively. In none of the patients an acute thromboembolic event (stroke or transient ischemic attack) or a pericardial effusion/tamponade occurred. A single transient phrenic nerve palsy was observed.

Conclusion: The new X3 EAS allows for single-shot fashioned ablation in terms of single-sweep PVI in half or more of PVs. The new RAPID ablation mode leads to an improved rate of first-pass isolation associated with very short procedure times without compromising safety.

Keywords: atrial fibrillation; balloon ablation; endoscopic ablation system; laser balloon; pulmonary vein isolation.

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References

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