1
|
Yamasaki T, Kakita K, Pak M, Hattori T. Quantitative comparison of the isolation lesions between conventional- and larger-sized visually guided laser balloon ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01738-6. [PMID: 38427180 DOI: 10.1007/s10840-024-01738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The importance of a wider circumferential isolation of the pulmonary veins (PV), which includes a large portion of the left atrial posterior wall (LAPW), has been suggested in several studies. However, the extended isolation area using a larger inflated visually guided laser balloon (VGLB) ablation remains to be elucidated. METHODS Seventy-eight patients with atrial fibrillation (AF) who underwent VGLB ablation were enrolled in this prospective study. An electroanatomic map of the left atrium was obtained before and after PV isolation (PVI) using a conventional-sized VGLB. The isolation areas were extended by the largest-sized VGLB ablation and remapped in the same manner. After the ablation, isolation areas were calculated with CARTO-3 system. The one-year atrial arrhythmia (Ata) recurrence was assessed. RESULTS: The largest-sized VGLB ablation yielded statistically greater areas of isolation in left-sided PV antrum (PVA) (11.5 ± 2.3 cm2 vs. 15.9 ± 3.5 cm2, P < .001) and right-sided PVA (14.2 ± 3.3 cm2 vs. 20.6 ± 4.4 cm2, P < .001) than the conventional-sized VGLB. Further, non-ablated LAPW (12.3 ± 4.4 cm2 vs. 7.8 ± 3.9 cm2, P < .001) was significantly reduced after largest-sized VGLB ablation, compared to the conventional-sized VGLB ablation. The one-year Ata freedom was 83.7% in patients with paroxysmal AF and 96.4% in those with persistent AF. CONCLUSION The largest-sized VGLB ablation technique can create a significantly wider isolation area of PVA and debulk a large amount of LAPW than the conventional-sized VGLB ablation. The one-year outcome was similarly high in paroxysmal and persistent AF.
Collapse
Affiliation(s)
- Takashi Yamasaki
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan.
| | - Ken Kakita
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan
| | - Misun Pak
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan
| | - Tetsuhisa Hattori
- Arrhythmia Care Center, Koseikai Takeda Hospital, 841-5 Higashi Shiokoji-Cho, Shiokoji-Dori Nishinotoin-Higashiiru, Shimogyo-Ku, Kyoto, 600-8558, Japan
| |
Collapse
|
2
|
Yamasaki T, Hattori T, Pak M, Kakita K. Left atrial roof region ablation using a visually guided laser balloon. Pacing Clin Electrophysiol 2024; 47:429-432. [PMID: 37221909 DOI: 10.1111/pace.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
Balloon-based catheter ablation including visually guided laser balloon (VGLB) has been adopted a first line therapeutic strategy for the patients with atrial fibrillation (AF). Recently, the roof area ablation beyond pulmonary vein (PV) isolation (PVI) using cryoballoon has been described as an effective therapy for the patients with persistent AF. However, the roof area ablation performed with a VGLB remains unknown. In this case, we report the case of roof area ablation for the patient with persistent AF using a VGLB.
Collapse
Affiliation(s)
| | | | - Misen Pak
- Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan
| | - Ken Kakita
- Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan
| |
Collapse
|
3
|
Ye W, Chen Q, Fan G, Zhou X, Wang X, Mao W, Li J. Efficacy and safety of visually guided laser balloon versus cryoballoon ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1229223. [PMID: 37674807 PMCID: PMC10478246 DOI: 10.3389/fcvm.2023.1229223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Background Newly developed catheter ablation (CA) techniques, such as laser balloon ablation (LBA) and cryoballoon ablation (CBA), have been introduced in recent years and emerged as valuable alternatives to conventional radiofrequency CA strategies for paroxysmal atrial fibrillation (PAF) patients. However, evidence comparing LBA and CBA remain controversial. Thus, we conducted this meta-analysis to assess the efficacy and safety between these two techniques. Methods Scientific databases (PubMed, Embase) and relevant websites (the Cochrane Library, ClinicalTrials.gov) were systematically searched from inception to March 2023. The primary outcomes of interest were the AF recurrence and the procedure-related complications. Secondary outcomes included procedural time, fluoroscopy time, and left atrial (LA) dwell time. Results Seven clinical trials with a total of 637 patients were finally enrolled. No significant differences were found between LBA and CBA in terms of AF recurrence [16.3% vs. 22.7%, odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.42-1.05, p = 0.078] or total procedural-related complications (8.4% vs. 6.4%, OR = 1.33, 95% CI: 0.71-2.51, p = 0.371). LBA had a significantly longer procedural time [weighted mean difference (WMD) = 38.03 min, 95% CI: 13.48-62.58 min, p = 0.002] and LA dwell time (WMD = 46.67 min, 95% CI: 14.63-78.72 min, p = 0.004) than CBA, but tended to have shorter fluoroscopy time. Conclusions LBA and CBA treatment have comparable efficacy and safety for PAF patients. LBA was associated with longer procedural and LA dwell times compared with CBA. Further large-scale studies are warranted to compare these two techniques with the newest generations.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426513, identifier (CRD42023426513).
Collapse
Affiliation(s)
- Wenyi Ye
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Qian Chen
- Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, China
| | - Guangci Fan
- Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, China
| | - Xinbin Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xiao Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Wei Mao
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - JuanJuan Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| |
Collapse
|
4
|
Ohkura T, Yamasaki T, Kakita K, Hattori T, Nishimura T, Iwakoshi H, Shimoo S, Shiraishi H, Matoba S, Senoo K. Comparison of maximum-sized visually guided laser balloon and cryoballoon ablation. Heart Vessels 2022; 38:691-698. [PMID: 36441215 PMCID: PMC10085885 DOI: 10.1007/s00380-022-02208-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
AbstractBalloon ablation therapy has recently been used for atrial fibrillation (AF) ablation. Laser balloons possess the property in which the balloon size can be changed. Standard laser balloon ablation (Standard LBA) was followed by additional ablation using a maximally extended balloon (Extended LBA) and its lesion characteristics were compared to cryoballoon ablation (CBA), another balloon technology. From June 2020 to July 2021, patients with paroxysmal AF who underwent an initial pulmonary vein (PV) isolation were enrolled. Sixty-five patients with paroxysmal AF were included, 32 in the LBA and 33 in the CBA group. To measure the isolated surface area after the ablation procedures, left atrial voltage mapping was performed after Standard LBA, Extended LBA, and CBA. The baseline patient characteristics did not differ between LBA and CBA. Extended LBA could successfully increase the isolated area more than Standard LBA for all four PVs. Compared to CBA, the isolated area of both superior PVs was significantly greater with Extended LBA (left superior PV: 8.5 ± 2.1 vs 7.3 ± 2.4, p = 0.04, right superior PV: 11.4 ± 3.7 vs 8.7 ± 2.7, p < 0.01), and thus the non-isolated posterior wall (PW) was smaller (8.5 ± 3.4 vs 12.4 ± 3.3, p < 0.01). Nevertheless, changes in the cardiac injury markers were significantly lower with LBA than CBA. There was no significant correlation between the cardiac injury level and isolated area in both groups. In conclusion, Extended LBA exhibited a significantly greater isolation of both superior PVs and resulted in a smaller non-isolated PW, but the cardiac injury markers were significantly suppressed as compared to CBA.
Collapse
Affiliation(s)
- Takashi Ohkura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Ken Kakita
- Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan
| | | | - Tetsuro Nishimura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hibiki Iwakoshi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Shimoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Keitaro Senoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| |
Collapse
|
5
|
Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort. J Cardiovasc Dev Dis 2021; 8:jcdd8120183. [PMID: 34940538 PMCID: PMC8704020 DOI: 10.3390/jcdd8120183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 01/29/2023] Open
Abstract
Laser balloon (LB) has emerged as an interesting strategy for pulmonary vein isolation in paroxysmal atrial fibrillation (AF). A third-generation LB has recently been developed, allowing a continuous ablation set. We aimed to compare the results from our center's experience with second and third-generation LBs to a cohort of matched patients who had undergone radiofrequency ablation (RFA) with contact-force catheters. This retrospective monocenter case-control study included our first 50 LB paroxysmal AF ablations (26 second and 24 third-generation LB) and 50 RFA controls, matched on age, sex and left atrial dilation. The two groups had similar baseline parameters. LB procedures were significantly shorter than RFA (129 (110-160) vs. 160 (119-198) min, p = 0.007). During AF ablation, two major complications occurred in each group. At the one-year follow-up, AF recurrence was diagnosed in 7 (14%) of the LB group vs. 14 (28%) of the RFA group (p = 0.14). Moreover, we observed that third-generation LB procedures were associated with shorter laser applications (22 (19-29) vs. 69 (55-76) min, p < 0.001) and procedural durations (111 (100-128) vs. 151.5 (128.5-167) min, p < 0.001) compared to second-generation LB procedures. In the context of the major increase in the number of AF ablations, LB demonstrated consistent results in terms of clinical success, complications and also reduced procedure durations compared to RFA.
Collapse
|
6
|
Tohoku S, Bordignon S, Bologna F, Chen S, Urbanek L, Operhalski F, Chun KJ, Schmidt B. Laser balloon in pulmonary vein isolation for atrial fibrillation: current status and future prospects. Expert Rev Med Devices 2021; 18:1083-1091. [PMID: 34618626 DOI: 10.1080/17434440.2021.1990754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Visually guided laser balloon (LB) catheter has been an established modality dedicated for pulmonary vein (PV) isolation in patients with atrial fibrillation. The newly updated version of this novel device has technically evolved recent years. AREAS COVERED This review will summarize the contemporary technical evolution of LB catheter. Available efficacy outcomes and the historical change of ablation style will be evaluated. Furthermore, the future perspectives for clinical practice are discussed. EXPERT COMMENTARY The initial LB ablation system provided comparable clinical results in PV isolation with other technologies, but with a unique strategical concept enabling the direct visualization of the tissue to cauterize. With multigenerational development, the LB catheter has been equipped with more compliant balloon for favorable PV occlusion and a robotically motor driven continuous ablation mode (RAPID mode). These technical innovations changed the concept of the ablation strategy using LB catheter as 'point-by-point' into 'single-shot' fashion. The remaining tasks are further improvements such as equipping with real-time recording system of intracardiac electrogram, durable structured balloon and the instrument for visualizing the cauterization area in a 360-degree panoramic view, which includes potential possibilities to develop this novel device to the more optimal device for PV isolation.
Collapse
Affiliation(s)
- Shota Tohoku
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Stefano Bordignon
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Fabrizio Bologna
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Shaojie Chen
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Lukas Urbanek
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Kr Julian Chun
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| |
Collapse
|
7
|
Tohoku S, Bordignon S, Chen S, Zanchi S, Bianchini L, Trolese L, Operhalski F, Urbanek L, Chun KRJ, Schmidt B. Single-sweep pulmonary vein isolation using the new third-generation laser balloon-Evolution in ablation style using endoscopic ablation system. J Cardiovasc Electrophysiol 2021; 32:2923-2932. [PMID: 34535929 DOI: 10.1111/jce.15245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 01/24/2023]
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.
Collapse
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Luca Trolese
- Universitäts Herzzentrum Freiburg-Bad Krozingen, Klinik für Kardiologie und Angiologie I, Freiburg, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3-Klinik für Kardiologie, Frankfurt, Germany
| |
Collapse
|
8
|
Evaluation of different ablation strategies verifying the optimal overlap ratio in point-by-point laser balloon ablation for patients with atrial fibrillation. Heart Rhythm O2 2021; 2:347-354. [PMID: 34430940 PMCID: PMC8369302 DOI: 10.1016/j.hroo.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
|
9
|
Validation of lesion durability following pulmonary vein isolation using the new third-generation laser balloon catheter in patients with recurrent atrial fibrillation. J Cardiol 2021; 78:388-396. [PMID: 34332839 DOI: 10.1016/j.jjcc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The second- and third-generation endoscopic ablation systems (EAS2 and EAS3) have been launched in recent years. We aimed to assess the lesion durability as well as gap localization using the multigenerational novel technologies in patients with recurrent atrial fibrillation (AF). METHODS Consecutive patients who underwent second ablation for recurrent AF following the initial pulmonary vein isolation (PVI) with EAS2 or EAS3 were retrospectively investigated. The persistent durability of PVI, gap localization at the second procedure, and procedural/anatomical features of durable PVI were analyzed. RESULTS Among 225 patients treated with EAS3 (N = 125) and EAS2 (N = 100), 34 patients (EAS3: 13 patients, 50 PVs, EAS2: 21 patients, 82 PVs) underwent a second procedure because of recurrent AF mean 11.9 ± 9.3 months after the initial procedure. Persistent isolation of all four PVs was recorded in 6 (46.2%) patients in EAS3 group and 4 (19.1%) patients in EAS2 group (p = 0.130). Ninety-one out of 132 (68.9%) PVs were persistently isolated with a higher rate in EAS3 group (82.0% vs. EAS2 group: 61.0%, p = 0.0113). A total of 45 gaps were recorded in 41 PVs. Right superior PV (RSPV) was the predominantly common reconnected vein (15 gaps, 14 PVs) irrespective of generations (EAS3: 4 gaps in 3 PVs and EAS2: 12 gaps in 11 PVs). Logistic multivariate regression analysis revealed ablation without reduced energy dose (5.5-7 W) as an independent predictor of durable PVI [adjusted OR: 3.70, 95% CI (1.408-10.003)], p = 0.008]. CONCLUSION The technical innovation resulted in a higher lesion durability in EAS3-guided PVI in patients with recurrent AF. The most common gap location was found at RSPV in successor EASs. Ablation without reduced energy was a predictor of durable PVI in successor EASs.
Collapse
|
10
|
Rovaris G, Ciconte G, Schiavone M, Mitacchione G, Gasperetti A, Piazzi E, Negro G, Montemerlo E, Rondine R, Pozzi M, Casiraghi M, De Ceglia S, Giacopelli D, Viecca M, Vicedomini G, Forleo GB, Pappone C. Second-generation laser balloon ablation for the treatment of atrial fibrillation assessed by continuous rhythm monitoring: the LIGHT-AF study. Europace 2021; 23:1380-1390. [PMID: 33837418 DOI: 10.1093/europace/euab085] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/20/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Balloon-based technologies have been developed to simplify catheter ablation of atrial fibrillation (AF), to improve the clinical outcome of the procedure and to achieve durable pulmonary vein isolation (PVI). The objective of this study is to evaluate the safety and efficacy of second-generation laser balloon (LB2) ablation in the treatment of AF using a continuous cardiac rhythm monitoring strategy. Atrial tachyarrhythmias (ATas) recurrences were assessed with implantable cardiac monitors (ICMs) or devices. METHODS AND RESULTS All patients underwent LB2 ablation procedure. The primary endpoint was the first recurrence of any, >5.5 and >24 h duration ATas after the blanking period (90 days). In-hospital visits were performed at 3, 6, and 12 months. Seventy-three patients (68% male, mean age 59.8 ± 11.3) were included in the study. The average procedure, fluoroscopy, and laser ablation times were 81.5 ± 30.1, 21.5 ± 12.4, and 33.8 ± 9.7, respectively. All PVs were isolated using the LB2 with no need of touch-up using focal catheters. No major complications occurred during or after the procedures. The one-year freedom from recurrences was 66.9% (95% CI: 57.0-76.7%), 81.0% (69.5-88.5%), and 86.8% (76.1-92.9%) considering any, 5.5-h and 24-h cut-off duration, respectively. At 3, 6, and 12 months, any ATas was recorded in 22%, 32%, and 25% of patients, with a ≥5% arrhythmic burden documented in 4%, 5%, and 3%, respectively. Few patients reported AF-related symptoms (7%, 8%, and 5%). CONCLUSION LB2 ablation is a safe and effective procedure, showing a high freedom from recurrences and low arrhythmic burden as documented by a continuous rhythm monitoring strategy.
Collapse
Affiliation(s)
- Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Schiavone
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Alessio Gasperetti
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Elena Piazzi
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Gabriele Negro
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Roberto Rondine
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Pozzi
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Mirko Casiraghi
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Sergio De Ceglia
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Daniele Giacopelli
- Biotronik Italia, Vimodrone, Milan, Italy.,Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Maurizio Viecca
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni B Forleo
- Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
11
|
Schmidt B, Petru J, Chun KRJ, Sediva L, Bordignon S, Chen S, Neuzil P. Pivotal Study of a Novel Motor-Driven Endoscopic Ablation System. Circ Arrhythm Electrophysiol 2021; 14:e009544. [PMID: 33570423 DOI: 10.1161/circep.120.009544] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Jan Petru
- Na Homolce Hospital, Prague, Czech Republic (J.P., L.S., P.N.)
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Lucie Sediva
- Na Homolce Hospital, Prague, Czech Republic (J.P., L.S., P.N.)
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., K.R.J.C., S.B., S.C.)
| | - Petr Neuzil
- Na Homolce Hospital, Prague, Czech Republic (J.P., L.S., P.N.)
| |
Collapse
|
12
|
Chun JKR, Bordignon S, Last J, Mayer L, Tohoku S, Zanchi S, Bianchini L, Bologna F, Nagase T, Urbanek L, Chen S, Schmidt B. Cryoballoon Versus Laserballoon: Insights From the First Prospective Randomized Balloon Trial in Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2021; 14:e009294. [PMID: 33417476 DOI: 10.1161/circep.120.009294] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon and laserballoon catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal atrial fibrillation (AF). METHODS Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either cryoballoon or laserballoon PVI (cryoballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF versus laserballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF). All antiarrhythmic drugs were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6, and 12 months. Primary efficacy end point was defined as freedom from atrial tachyarrhythmia between 90 and 365 days after a single ablation. Secondary end points included procedural parameters and periprocedural complications. RESULTS Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (cryoballoon) versus 95% (laserballoon) requiring focal touch-up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the cryoballoon group (50.9±21.0 versus 96.0±20.4 minutes; P<0.0001 and 7.4±4.4 versus 8.4±3.2 minutes, P=0.083). Overall, the primary end point of no atrial tachyarrhythmia recurrence was met in 79% (cryoballoon: 80.0% versus laserballoon: 78.0%, P=ns). No death, atrio-esophageal fistula, tamponade, or vascular laceration requiring surgery occurred. In the cryoballoon group, 8 transient but no persistent phrenic nerve palsy were noted compared with 2 persistent phrenic nerve palsy and one transient ischemic attack in the laserballoon group. CONCLUSIONS Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.
Collapse
Affiliation(s)
- Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.).,Medizinische Klinik II, Kardiologie/Angiologie/Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Germany (J.K.R.C.)
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Mayer
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Kardiologie, Agaplesion Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C., S.B., J.L., L.M., S.T., S.Z., L.B., F.B., T.N., L.U., S.C., B.S.)
| |
Collapse
|
13
|
Keeping it Simple: Balloon Devices for Atrial Fibrillation Ablation Therapy. JACC Clin Electrophysiol 2020; 6:1577-1596. [PMID: 33213820 DOI: 10.1016/j.jacep.2020.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation is a common disease of increasing prevalence. Catheter ablation has evolved into an established therapeutic option that mainly aims to electrically isolate the pulmonary veins from atrial myocardium. The traditional method comprises point-by-point radiofrequency current ablation guided by electroanatomical mapping and has proven to be effective and safe in experienced hands. However, this approach is technically highly demanding and associated with a long learning curve, limiting its widespread utilization. To address these shortcomings, simplified ablation tools for pulmonary vein isolation are needed. In this context, balloon devices promise to ease the procedure by approaching the entire orifice of a targeted pulmonary vein in a single maneuver. This requires less catheter manipulation in the left atrium and often allows ablation of a large volume of tissue with a single application of ablative energy. Two balloon devices-one using cryoenergy, the other laser energy-have already been established in clinical routine and have demonstrated noninferiority when compared with radiofrequency ablation in large randomized trials. More balloon devices are on the verge of being introduced into clinical practice and bear the potential to expand the interventional electrophysiologist's armamentarium when treating atrial fibrillation. The authors review the use of the established balloon devices available for atrial fibrillation ablation and provide a detailed outlook on upcoming balloon technologies, including 3 different balloons utilizing radiofrequency energy as well as a novel cryoballoon.
Collapse
|
14
|
Nagase T, Kobori A, Inaba O, Sasaki Y, Tomizawa N, Asano S, Fukunaga H, Mabuchi K, Inoue K, Tanizaki K, Murai T, Iguchi N, Nitta J, Isobe M. Comparison of dragging ablation and point-by-point ablation with a laser balloon on linear lesion formation. J Cardiovasc Electrophysiol 2020; 31:2848-2856. [PMID: 32786049 DOI: 10.1111/jce.14714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/24/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Lesion size and continuity in dragging laser balloon (LB) ablation, which may enable fast and durable pulmonary vein isolation for atrial fibrillation, are unknown. We evaluated the differences in size and continuity of linear lesions formed by dragging ablation and conventional point-by-point ablation using an LB in vitro model. METHODS AND RESULTS Chicken muscles were cauterized using the first-generation LB in dragging and point-by-point fashion. Dragging ablation was manually performed with different dragging speeds (0.5-2°/s) using an overlap ratio of the beginning and last site during one application at 12 W/20 s and 8.5 W/30 s. Point-by-point ablation was performed with 25% and 50% overlap ratios at six energy settings (5.5 W/30 s to 12 W/20 s). Lesion depth, width, and continuity were compared. Lesion continuity was assessed by the surface and deep visible gap degree categorized from 1 (perfect) to 3 (poor). Twenty lesions were evaluated for each ablation protocol. Lesion depth and width in dragging ablation at high power (12 W) were comparable with most measurements in point-by-point ablation. Lesion depth and width were smaller at faster-dragging speed and lower power (8.5 W) in dragging ablation. The surface visible gap degree was better in dragging ablation at all dragging speeds than a 25% overlapped point-by-point ablation (p < .001). CONCLUSION Dragging LB ablation at high power provides deep and continuous linear lesion formation comparable with that of point-by-point LB ablation. However, lesion depth and width depending on the dragging speed and power.
Collapse
Affiliation(s)
- Takahiko Nagase
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Osamu Inaba
- Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan
| | - Yasuhiro Sasaki
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Naoki Tomizawa
- Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan
| | - So Asano
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Hiroshi Fukunaga
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Kei Mabuchi
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Kohei Tanizaki
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Tatsuya Murai
- Department of Pathology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| |
Collapse
|
15
|
Heeger CH, Tiemeyer CM, Phan HL, Meyer-Saraei R, Fink T, Sciacca V, Liosis S, Brüggemann B, Große N, Fahimi B, Reincke S, Kuck KH, Ouyang F, Vogler J, Eitel C, Tilz RR. Rapid pulmonary vein isolation utilizing the third-generation laserballoon - The PhoeniX registry. IJC HEART & VASCULATURE 2020; 29:100576. [PMID: 32642555 PMCID: PMC7334810 DOI: 10.1016/j.ijcha.2020.100576] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 11/20/2022]
Abstract
Background Balloon-based ablation systems for pulmonary vein isolation (PVI) are providing procedural safety and efficacy as well as favourable clinical outcome. Although second-generation laser balloon (LB2) based PVI has been shown safety and efficacy relatively long procedural duration was a strong limitation. The third-generation laser balloon (LB3) offers and automized ablation for rapid PVI. We determined safety, efficacy and procedural characteristics of this new promising ablation system. Methods and results A total of 15 consecutive patients were prospectively enrolled. All patients underwent PVI using the LB3. A total 59/59 PVs (100%) were successfully isolated. Procedural data was compared to the last 15 consecutive patients treated by the LB2. The median procedure time significantly declined from LB2 (91 (86, 105) min) to LB3 (77 (68, 87) min), p < 0.001. Similarly, the median left atrial dwelling time significantly decreased from LB2 (72 (62, 84) min) to LB3 (45 (38, 52) min), p < 0.0001. The total laser time decreased from LB2 (1920 (1765, 2193) sec) to LB3 (1077 (896, 1165) sec), p < 0.00001. A pure single shot PVI was performed in 18/59 PVs (31%). For major adverse events no differences were detected between the groups (LB2 1/15 (6.7%) and LB3 1/15 (6.7%), p = 0.999). Conclusion The LB3 was safe and effective for PVI. Procedure time, LA dwelling time and total laser time significantly decreased compared to LB2.
Collapse
Affiliation(s)
- Christian-H. Heeger
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Corresponding author at: Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Christian M. Tiemeyer
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Huong-Lan Phan
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Roza Meyer-Saraei
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Thomas Fink
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Vanessa Sciacca
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Spyridon Liosis
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Ben Brüggemann
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Niels Große
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Bezhad Fahimi
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Samuel Reincke
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
- LANS Cardio, Stephansplatz 5, 20354 Hamburg, Germany
| | - Feifan Ouyang
- Fuwai Hospital/National Center of Cardiovascular Diseases, Beijing, China
| | - Julia Vogler
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Roland R. Tilz
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| |
Collapse
|
16
|
Heeger CH, Phan HL, Meyer-Saraei R, Fink T, Sciacca V, Liosis S, Brüggemann B, Große N, Fahimi B, Sano M, Kuck KH, Ouyang F, Vogler J, Eitel C, Tilz RR. Second-Generation Visually Guided Laser Balloon Ablation System for Pulmonary Vein Isolation: Learning Curve, Safety and Efficacy ― The MERLIN Registry ―. Circ J 2019; 83:2443-2451. [DOI: 10.1253/circj.cj-19-0766] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christian-H. Heeger
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck
| | - Huong-Lan Phan
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Roza Meyer-Saraei
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Thomas Fink
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Vanessa Sciacca
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Spyridon Liosis
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Ben Brüggemann
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Niels Große
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Bezhad Fahimi
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Makoto Sano
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Feifan Ouyang
- Fuwai Hospital/National Center of Cardiovascular Diseases
| | - Julia Vogler
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck
| |
Collapse
|
17
|
Chun JKR, Bordignon S, Chen S, Tohoku S, Bologna F, Urbanek L, Schmidt BH. Current Status of Atrial Fibrillation Ablation with Balloon Strategy. Korean Circ J 2019; 49:991-1001. [PMID: 31646768 PMCID: PMC6813157 DOI: 10.4070/kcj.2019.0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 01/09/2023] Open
Abstract
Catheter ablation of atrial fibrillation (AF) has been established worldwide and is recommended for symptomatic paroxysmal AF patients according to international guidelines. Importantly, the cornerstone of any AF ablation represents pulmonary vein isolation (PVI). Traditional radiofrequency (RF) point by point ablation within a 3D electroanatomic left atrial (LA) map requires profound understanding of LA anatomy and electrophysiology. This ablation strategy can be highly efficient and safe if performed in experienced hands and centers. However, procedural complexity causes a long learning curve and has limited its wide spread utilization. In contrast, balloon based PVI ablation strategies are based on an anatomic principle. Currently, two balloon types (cryoballoon and laserballoon) have been adopted to clinical routine. Both balloons are positioned at the target PV and circumferential energy ablation is enabled. This simplified anatomic approach facilitates reaching the procedural endpoint of PVI and demonstrated less operator dependency. Therefore, balloon PVI appears to be associated with improved procedural reproducibility and safety. Importantly, large scale randomized trials proved non-inferiority of balloon guided AF ablation (cryothermal and laser energy) vs. experienced operators using traditional “gold standard” RF ablation in paroxysmal and persistent AF. Ongoing technological refinements of both balloons as well as the introduction of novel energy dosing strategies and ablation targets may potentially impact the current way of ablating AF in future. This review will summarize current clinical experience of contemporary balloon devices and will look into future developments.
Collapse
Affiliation(s)
- Julian Kyoung Ryul Chun
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - Stefano Bordignon
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shaojie Chen
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Lukas Urbanek
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Heinrich Schmidt
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|