Open AccessWide area circumferential ablation for pulmonary vein isolation using radiofrequency versus laser balloon ablation
Author(s) -
Skeete Jamario,
Sharma Parikshit S.,
Kenigsberg David,
Pietrasik Grzegorz,
Osman Ahmed F.,
Ravi Venkatesh,
DuFaydeLavallaz Jeanne M.,
Post Zoe,
Wasserlauf Jeremiah,
Larsen Timothy R.,
Krishnan Kousik,
Trohman Richard,
Huang Henry D.
Publication year - 2022
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12722
Subject(s) - medicine , ablation , atrial fibrillation , atrial tachycardia , pulmonary vein , cardiology , balloon , radiofrequency ablation , catheter ablation , fluoroscopy , rf ablation , surgery
Background Persistent atrial fibrillation (AF) is associated with high recurrence rates of AF and atypical atrial flutters or tachycardia (AFT) postablation. Laser balloon (LB) ablation of the pulmonary vein (PV) ostia has similar efficacy as radiofrequency wide area circumferential ablation (RF‐WACA); however, an approach of LB wide area circumferential ablation (LB‐WACA) may further improve success rates. Objective To evaluate freedom from atrial tachyarrhythmia (AFT/AF) recurrence postablation using RF‐WACA versus LB‐WACA in persistent AF patients. Methods This was a retrospective multicenter study. Patients were followed for up to 24 months via office visits, Holter, and/or device monitoring. The primary endpoint was freedom from AFT/AF after a single ablation procedure. Secondary endpoints included freedom from AF, freedom from AFT, first‐pass isolation of all PVs, and procedural complications. Results Two hundred and four patients were studied (LB‐WACA: n = 103; RF‐WACA: n = 101). Patients’ baseline characteristics were similar except patients in the RF‐WACA group were older (64 vs. 68, p = .03). First‐pass isolation was achieved more often during LBA (LB‐WACA: 88% vs. RF‐WACA 75%; p = .04). Procedure ( p = .36), LA dwell ( p = .41), and fluoroscopy ( p = .44) time were similar. The mean follow‐up was 506 ± 279 days. Sixty‐six patients had arrhythmic events including 24 AFT and 59 AF recurrences. LB‐WACA group had higher arrhythmia‐free survival ( p = .009) after single ablation procedures. In the multivariate Cox regression model, RF‐WACA was associated with a higher recurrence of AFT compared with LB‐WACA (Adjusted HR 3.16 [95% CI: 1.13–8.83]; p = .03). Conclusions LB‐WACA was associated with higher freedom from atrial arrhythmias mostly driven by the lower occurrence of AFT compared with RF‐WACA.