Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort

Abstract

Laser balloon (LB) has emerged as an interesting strategy for pulmonary vein isolation in paroxysmal atrial fibrillation (AF). A third-generation LB has recently been developed, allowing a continuous ablation set. We aimed to compare the results from our center’s experience with second and third-generation LBs to a cohort of matched patients who had undergone radiofrequency ablation (RFA) with contact-force catheters. This retrospective monocenter case-control study included our first 50 LB paroxysmal AF ablations (26 second and 24 third-generation LB) and 50 RFA controls, matched on age, sex and left atrial dilation. The two groups had similar baseline parameters. LB procedures were significantly shorter than RFA (129 (110–160) vs. 160 (119–198) min, p = 0.007). During AF ablation, two major complications occurred in each group. At the one-year follow-up, AF recurrence was diagnosed in 7 (14%) of the LB group vs. 14 (28%) of the RFA group (p = 0.14). Moreover, we observed that third-generation LB procedures were associated with shorter laser applications (22 (19–29) vs. 69 (55–76) min, p < 0.001) and procedural durations (111 (100–128) vs. 151.5 (128.5–167) min, p < 0.001) compared to second-generation LB procedures. In the context of the major increase in the number of AF ablations, LB demonstrated consistent results in terms of clinical success, complications and also reduced procedure durations compared to RFA.

Efficacy and Safety of Laser Balloon Versus Irrigated Radiofrequency Ablation as Initial Therapies for Atrial Fibrillation: A Meta-Analysis

“…Twelve trials [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] were included in this study (Fig. 1 ).…”

“…In addition, LBA can adapt to various PV anatomies with a compli-ant balloon, which can also provide operators with greater flexibility with energy titration [17]. Since the first multicenter RCT by Dukkipati et al [10], many trials have compared the safety and efficacy of LBA vs. RFA, although the results remain controversial, especially when the newer generations of both techniques were introduced [13].…”

Chronic Kidney Disease with Mild and Mild to Moderate Reduction in Renal Function and Long-Term Recurrences of Atrial Fibrillation after Pulmonary Vein Cryoballoon Ablation

“…Our findings are noteworthy because they are derived from a multi-center collection of data from Italian centers using cryoballoon ablation, a technique widely implemented in daily practice [ 13 , 17 , 18 , 19 ]. A report from China dealing with patients treated with either radiofrequency ablation or cryoballoon ablation in a single center (Guangzhou, China) highlighted a stepwise increase in the risk of AF recurrence as CKD worsened up to severe CKD, using the Modification of Diet in Renal Disease (MDRD) equation for estimating the eGFR [ 20 ].…”

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

“…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 ]. In another study of patients requiring redo procedures with second- and third-generation LB due to AF recurrence, persistent PVI was more frequent in the third-generation LB [ 88 ].…”