Comparison of maximum-sized visually guided laser balloon and cryoballoon ablation

Abstract

Balloon 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.

Efficacy and safety of visually guided laser balloon versus cryoballoon ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis

“…Six studies ( 6 , 7 , 11 – 14 ) provided information on procedural time of LBA and CBA. Results demonstrated that, LBA had a significantly longer procedural time than CBA (WMD = 38.03 min, 95% CI: 13.48–62.58 min, p = 0.002).…”

“…Seven clinical trials (6,7,(10)(11)(12)(13)(14) from 88 potentially relevant studies were finally included in the meta-analysis (Figure 1). A total of 637 patients receiving initial ablation for PAF (LBA, n = 311 vs. CBA, n = 326) were studied.…”

“…Several studies have compared the characteristics, efficacy, and safety between LBA and CBA as initial therapies for PAF patients; however, the results remain controversial ( 6 , 7 ). Therefore, the aim of the present meta-analysis was to investigate the efficacy, safety, and procedural characteristics between LBA and CBA for PAF patients in light of the latest evidence.…”

Optimal procedural selection for atrial fibrillation catheter ablation to minimize myocardial injury and inflammatory reaction

“…1 For instance, left atrial voltage mapping may illustrate the isolated surface area and elucidate the degree of myocardial injury in each procedure. 2 Their finding that PFA was associated with the lowest inflammatory reaction contradicts the aforementioned result. The authors hypothesized that PFA selectively injures myocytes, which have a lower threshold for electroporation, thereby minimizing the inflammatory reaction.…”