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Observational Study
. 2023 Dec;66(9):2081-2089.
doi: 10.1007/s10840-023-01544-6. Epub 2023 Apr 15.

Pulmonary vein isolation by visually guided laser balloon ablation: single-center 5-year follow-up results

Pieter Koopman  1   2 , Thalia Bekelaar  3 , Joris Schurmans  3 , Thomas Phlips  3 , Dagmara Dilling-Boer  3 , Johan Vijgen  3
Affiliations
Observational Study

Pulmonary vein isolation by visually guided laser balloon ablation: single-center 5-year follow-up results

Pieter Koopman et al. J Interv Card Electrophysiol. 2023 Dec.

Abstract

Background: Visually guided laser balloon (VGLB) ablation is a balloon-based treatment for atrial fibrillation (AF) that uses a titratable laser energy source to perform pulmonary vein isolation (PVI), allowing for real-time visualization of target tissue and ablation lesions through an endoscopic camera. Few long-term data on this technique are currently available. This report presents acute efficacy, procedural data, complication rates, and long-term AF-free survival up to 5 years post-ablation.

Methods: In this single-center, retrospective, observational report, 152 patients (72.4% male, mean age 60.6 ± 9.7 years, 62.5% paroxysmal AF, 598 pulmonary veins in total) treated with the first-generation VGLB system between 2014 and 2016 were included for analysis. AF ablation consisted of PVI only.

Results: Acute PVI was achieved in 98.2% of veins, with first-pass isolation in 92.5%. Procedure duration of 129 min [IQR 113-150], fluoroscopy time of 15 min [IQR 11-20], and dose area product of 5016 mGy·cm2 [IQR 3603-8711] were recorded. During a median follow-up of 51 months [IQR 45-57], 74.3% of patients remained free of AF (78.8% for paroxysmal and 65.3% for persistent AF, p = 0.108). Freedom of AF at 1, 2, 3, and 4 years follow-up was 88.2%, 82.2%, 78.9%, and 74.8%, respectively. PV reconnections were identified in only 46.9% of redo procedures. The median number of PV reconnections during redo procedures was 0 [IQR 0-2]. Anti-arrhythmic drug use was significantly reduced after ablation (p < 0.001). The most commonly reported complications were minor vascular complications (4.6%) and transient phrenic nerve paralysis (3.3%).

Conclusions: First-generation VGLB ablation demonstrated high acute isolation rates, reasonable procedure times and low complication rates. Long-term freedom from AF was 78.8% for paroxysmal AF and 65.3% for persistent AF, performing PVI only.

Keywords: Ablation; Atrial fibrillation; Laser balloon; Long-term follow-up; Pulmonary vein isolation.

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Conflict of interest statement

P. Koopman has received speaker and consultant honoraria from Cardiofocus and Medtronic. J Vijgen has received speaker and consultant honoraria from Cardiofocus. All other authors: none declared.

Figures

Fig. 1
Fig. 1
Learning curves (best fit) representing reduction in procedural duration (A), fluoroscopy times (B), and radiation dose (C) as experience grows
Fig. 2
Fig. 2
Kaplan–Meier curves of AF-free survival (on/off AAD) after visually guided laser balloon ablation in patients with non-paroxysmal (persistent) AF (green) or paroxysmal AF (blue) (p = 0.108). Estimated percentages for freedom of AF at 12, 24, 36, 48, and 60 months of follow-up are indicated
See this image and copyright information in PMC

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