Laser Balloon or Wide-Area Circumferential Irrigated Radiofrequency Ablation for Persistent Atrial Fibrillation

Schmidt, Boris; Neužil, Petr; Luik, Armin; Asensi, Joaquín Osca; Schrickel, Jan W.; Deneke, Thomas; Bordignon, Stefano; Petrů, Jan; Merkel, Matthias; Šedivá, Lucie; Klostermann, Annemarie; Perrotta, Laura; Cano, Óscar; Chun, K.R. Julian

doi:10.1161/circep.117.005767

Cited by 80 publications

(86 citation statements)

References 28 publications

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“…The left atrial structural abnormalities identified by late gadolinium enhancement magnetic resonance imaging or bipolar voltage mapping (i.e., left atrial low‐voltage area, LALVA) were identified as predictors for atrial tachyarrhythmia recurrence after irrigated radiofrequency current PVI and are currently evaluated as new ablation targets . On the other hand, laser balloon (HeartLight, CardioFocus, Marlborough, MA, USA) has proven efficacy similar to irrigated radiofrequency current PVI . Theoretically, although the difference in durability of PVI between laser balloon (i.e., balloon‐based) ablation and radiofrequency current ablation remains unclear, LALVA seems to be a predictor of the atrial tachyarrhythmia recurrence even in laser balloon ablation.…”

Section: Introductionmentioning

confidence: 99%

HEartLight guided – PUre Pulmonary Vein Isolation Regardless of Concomitant Atrial Substrate: HEURECA Study

Nagase

Bordignon

Perrotta

et al. 2018

Pacing Clinical Electrophis

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Background It remains unclear whether left atrial low‐voltage area (LALVA) affects atrial tachyarrhythmia recurrence after laser balloon pulmonary vein isolation (PVI) for atrial fibrillation (AF). We prospectively evaluated the outcome of laser balloon PVI in patients with and without LALVA (≤ 0.5 mV) together with surface/intracardiac electrophysiological criteria. Methods One hundred consecutive paroxysmal/persistent AF patients underwent laser balloon PVI. The relative extent of LALVA (extent of LALVA/left atrial surface area × 100 [%]: rLALVA), total p‐wave duration in lead II (PWD), and time interval from the beginning of p‐wave to the local activation in left atrial appendage (TTLAA) were assessed. Patients were divided into patients with LALVA (group A: 23 patients) and those without LALVA (group B: 77 patients). The primary endpoint was freedom from atrial tachyarrhythmia after the blanking periods. Results Complete PVI was achieved in 99/100 (99%) patients. PWD and TTLAA were longer in group A (both, P < 0.001). During 12 months’ follow‐up, survival free from atrial tachyarrhythmia recurrence was lower in group A (12/23 [52%] patients vs 67/77 [87%] patients, P < 0.001). Multivariate analysis identified rLALVA as the only independent predictor of atrial tachyarrhythmia recurrence. rLALVA correlated with PWD and TTLAA (r = 0.41, P < 0.001 and r = 0.60, P < 0.001, respectively). Receiver operating characteristic curve for rLALVA revealed PWD of 122 ms and TTLAA of 92 ms as the optimal cut‐off value. Conclusion LALVA was associated with poorer outcome after laser balloon PVI. Patients may be identified by longer PWD and TTLAA.

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Section: Introductionmentioning

confidence: 99%

HEartLight guided – PUre Pulmonary Vein Isolation Regardless of Concomitant Atrial Substrate: HEURECA Study

Nagase

Bordignon

Perrotta

et al. 2018

Pacing Clinical Electrophis

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“…In a multicenter trial published last year, 20 134 patients with persistent AF were randomized to undergo either laser balloon ablation or wide area circumferential PVI using radiofrequency. The freedom from AF rates was comparable between the groups (Figure 2).…”

Section: Cryoablation and Laser Balloon Ablationmentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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1 In the past year, there have been key advances in our understanding of arrhythmia mechanisms and diagnosis and important new therapies. We have seen advances in basic cardiac electrophysiology with demonstration of optogenetic targeting of atrial fibrillation (AF) rotors, induced pluripotent stem cell-based biological pacemakers, small-conductance Ca 2+ -activated K + (SK) channels as targets for AF treatment, and reductions in inward rectifier potassium current in promoting ventricular fibrillation. Hand-held ECG devices and implantable loop recorders have been shown to detect subclinical AF. Catheter ablation of AF in patients with left ventricular dysfunction improves outcomes compared with medical therapy. Both hybrid thoracoscopic surgical and catheter ablation procedures and off-pump surgery for AF have demonstrated efficacy. Anticoagulation with uninterrupted dabigatran had a lower major bleeding rate compared with uninterrupted warfarin after AF ablation. Studies have examined optimizing access to automatic external defibrillators by identifying optimal locations for placement and possibility of using a drone delivery network. In long-QT syndrome, there are advances in understanding of ECG predictors of arrhythmic events, the role of the role of gene variants in conferring arrhythmic risk, and effect of age and sex on QTc interval. There are numerous advances in the treatment of ventricular tachycardia, including noninvasive cardiac radiation. Catheter ablation and implantable devices continue to demonstrate effectiveness in patients with congenital heart disease.In the past year, there have been numerous ground-breaking discoveries and observations that illustrate the vibrancy and promise of our field. In this review, we have tried to capture articles published in the year 2017 of particular interest to cardiac electrophysiologists. Although we have focused on articles from our journal, we have captured many of the most impactful articles in numerous other journals. We apologize for omitting a large number of other important articles that cannot be included in this review because of space limitations. We have placed some of these in our Data Supplement. BASIC ELECTROPHYSIOLOGY BradyarrhythmiasThe search for new biological therapies for bradycardia met with recent progress as human keratinocytes genetically reprogrammed into electrically unstable cardiomyocytes were shown to persist and provide continued catecholaminergic-responsive pacing for 13 weeks after subepicardial injection into immunosuppressed dogs at the time of atrioventricular (AV) node ablation.1 Although only 40% to 80% of the beats matched the site of cell injection, this is first study to test a human induced pluripotent stem cell-based biological pacemaker in a large animal model of heart block and represents an important step forward in biological pacing.

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“…Initial experience with Laser ablation demonstrated an acute electrical PVI success rate close to 100%, which is similar to RF . Clinical efficacy of Laser ablation in preventing AF recurrence also appears to be similar to RF and cryoablation in both paroxysmal and persistent AF . However, the PV electrical reconnection rate after Laser ablation appears to be lower than that reported for RF ablation .…”

Section: Discussionmentioning

confidence: 85%

“…In a study that was limited by the very small Initial experience with Laser ablation demonstrated an acute electrical PVI success rate close to 100%, which is similar to RF. 12,30 Clinical efficacy of Laser ablation in preventing AF recurrence also appears to be similar to RF 11,16,31 and cryoablation 14,15 in both paroxysmal 9,11,13 and persistent AF. 16,31 However, the PV electrical reconnection rate…”

Section: Discussionmentioning

confidence: 88%

“…The reasons for the apparent discrepancy between the greater anatomical efficacy of durable PVI achieved by Laser compared with RF and the similar clinical efficacy of the two techniques are not clear, but it may be related to several factors: (1) Most published studies were underpowered to detect differences because of small sample sizes. Indeed, the largest published study included only 68 patients with persistent AF for Laser ablation and 66 for RF ablation, which is much lower compared with studies that compared cryoablation with RF (over 375 patients per group) . (2) Most studies included the first patients in whom Laser was performed in that center, so the operator's learning curve may have been a factor.…”

Section: Discussionmentioning

confidence: 99%

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Postprocedural LGE‐CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation

Ventura

Mărgulescu

Benito

et al. 2018

Cardiovasc electrophysiol

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Laser Balloon or Wide-Area Circumferential Irrigated Radiofrequency Ablation for Persistent Atrial Fibrillation

Abstract: https://www.clinicaltrials.org. Unique identifier: NCT01863472.

Cited by 80 publications

References 28 publications

HEartLight guided – PUre Pulmonary Vein Isolation Regardless of Concomitant Atrial Substrate: HEURECA Study

HEartLight guided – PUre Pulmonary Vein Isolation Regardless of Concomitant Atrial Substrate: HEURECA Study

Year in Review in Cardiac Electrophysiology

Postprocedural LGE‐CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation

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