Effectiveness of a manual dragging laser irradiation technique using the first‐generation endoscopic laser balloon ablation system for pulmonary vein isolation

Abstract

Background: Although high efficacy of laser balloon (LB) ablation for atrial fibrillation (AF) has been shown, the conventional point-by-point technique requires a long procedure time. We investigated the clinical effectiveness of the manual dragging laser technique. Methods:We enrolled 51 consecutive patients with paroxysmal AF who underwent pulmonary vein isolation (PVI) using first-generation LB (LB1) at our institution. The first 25 patients underwent PVI using a point-by-point laser irradiation maneuver (point-by-point group). The latter 26 patients underwent PVI using a manually dragging laser irradiation maneuver (dragging group). The power and delivery time for the laser energy were selected from a preset protocol with 5.5-12 W and 20-30 s for each application. The dragging irradiation method was performed by manually rotating approximately 1.5°/s during one irradiation application.Results: PVI was successful in all cases. The duration of PVI was shorter (66 ± 20 vs. 116 ± 39 min, p < 0.0001), and the number of laser irradiations for the 4PVs were significantly less in the dragging group. There were four recurrent cases (16%) in the point-by-point group and 1 (4%) in the dragging group. There was no significant difference in the survival rate free from recurrence after the blanking period between the two groups (log-rank p = 0.1570). The complications were similar between the groups (4% vs. 4%, ns). Conclusions:The manual dragging laser irradiation technique using LB1 could shorten the PVI procedure time while preserving clinical effectiveness.

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

“…Additionally, a wide-area circumferential LB ablation led to a greater arrhythmia-free interval compared to a wide-area circumferential RF ablation in a retrospective multicenter study [ 85 ]. Moreover, a manual dragging laser irradiation technique could shorten the procedure duration without compromising efficacy or safety, as shown in the study of Sasaki et al [ 86 ]. Third-generation LB ablation is characterized by a shorter laser application and procedure duration compared to second-generation, with a similar effect [ 87 ].…”