HRS: Laser balloon catheter can isolate pulmonary vein in AF patients

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SAN FRANCISCO—Use of a visually guided laser balloon ablation catheter (BAC) achieved an 86 percent success rate in isolation of pulmonary veins (PV) in paroxysmal atrial fibrillation (AF) patients, according to a study presented May 4 at the 32nd annual meeting of the Heart Rhythm Society (HRS).

“In patients with paroxysmal AF, acute PV isolation can be achieved in the vast majority of cases,” the study's lead author Srinivas Dukkipati, MD, from Mount Sinai School of Medicine in New York City, said during the presentation. “However, the durability of PV isolation is suboptimal and pulmonary vein reconnections account for clinical recurrences.”

The study enrolled 56 drug-refractory paroxysmal AF patients who underwent catheter ablation with BAC at three participating centers. After patients underwent transseptal puncture, the researchers placed a 12-French sheath at the target PV and inflated the BAC at the ostium. Endoscopic guidance (HeartLight Endoscopic Ablation System; CardioFocus) was used to place the lesion around the PV.

Patients underwent a repeat procedure to assess PV isolation at three months. The mean age of patients was 57.1 years, 64 percent of the study participants were male and 36 percent were female.

Dukkipati reported that they were able to isolate 200 of 204 pulmonary veins in the 56 patients when the endoscopic device was used. An average of 1.1 catheters was used in each patient. Fifty-two patients returned for remapping. After remapping, the researchers reported that 85 percent of pulmonary veins were isolated and electrical isolation of all PVs occurred in 60 percent of patients.

Seven patients had AF recurrence and had complete electric isolation of the PVs, “suggesting a non-PV trigger for atrial fibrillation.” Eighty-six percent of all PVs were isolated at three months, Dukkipati noted.

“These data are significant because diagnostic remapping in asymptomatic patients is rarely attempted,” said Dukkipati. “In this case, remapping has enabled us to clearly confirm quality outcomes, demonstrating that the visually-guided laser balloon catheter can achieve persistent, long-lasting pulmonary vein isolation in paroxysmal atrial fibrillation patients.”