Rapid mode in novel generation visually guided laser balloon system: feasibility, safety, and impact on procedural outcomes

Autor: C Martignani, M Ziacchi, G Statuto, A Spadotto, A Angeletti, G Massaro, L Bartoli, M Orlandi, I Diemberger, S Ginex, F Provasi, D Grassini, N Galie, M Biffi
Rok vydání: 2022
Předmět:
Zdroj: EP Europace. 24
ISSN: 1532-2092
1099-5129
Popis: Funding Acknowledgements Type of funding sources: None. Background Laser balloon (LB) systems are increasingly used for pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation (AF). The novel generation of the visually guided LB system includes a rapid mode (RM) feature, which potentially allows a continuous circumferential lesion for PVI. Nevertheless, data on its practicability and on its impact on procedural outcomes are lacking. Purpose To analyse the applicability of RM and its effect on procedural and fluoroscopic time in a cohort of patients who underwent catheter ablation of AF using a LB system. Methods Between September 2020 and December 2021, we prospectively included all consecutive patients who underwent PVI with LB at our centre. All the procedures were performed by the same two operators. For each pulmonary vein (PV), we firstly attempted to obtain a complete circumferential lesion at 13 W using the RM. If its application was not possible or incomplete, we performed additional single lesions at 5.5, 8.5 or 13 W to achieve complete visual PVI. Finally, we calculated the percentage of singular and total circumferential lesions made with RM for every procedure and evaluated its influence on procedural outcomes. Results 75 patients were enrolled. We identified and successfully isolated 289 PVs, with mean procedural and fluoroscopic time of 171±51 and 38±15 min, respectively. Use of RM for more than 70% of the circumferential lesion was possible in 185 veins (64%), while we obtained complete isolation using only RM in 90 veins (31%). Reasons for interruption of RM were unfavourable anatomy, imperfect visualization of the ostium of the PV and presence of blood between the balloon and the anatomic substrate. For each vein, we observed a significantly shorter ablation (13±8 vs 23±12 min, p70% of the circumferential lesion was made through RM. Further, total procedural (157 ±52 vs 192±42 min, p0.001) and fluoroscopic time (30±15 vs 36.9±14 min, p 0.025) were significantly shorter if more than 70% of total circumferential lesion was achieved through rapid mode. There were five pinhole balloon ruptures during application of RM. No major complication occurred. Conclusions RM is a novel feature in the latest generation of LB system. In our cohort, it showed good applicability and safety, while significantly reducing procedural times. Further studies are needed to understand its possible impact on clinical outcomes.
Databáze: OpenAIRE
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