Feasibility of the Radiofrequency Hot Balloon Catheter for Isolation of the Posterior Left Atrium and Pulmonary Veins for the Treatment of Atrial Fibrillation

Abstract

Background-Atrial fibrillation originates mostly from the pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (LA). The present study was designed to evaluate the feasibility and safety of a novel radiofrequency hot balloon catheter for the treatment of patients with atrial fibrillation by electrically isolating the posterior LA, including all PVs. Methods and Results-One hundred consecutive patients with drug-resistant atrial fibrillation (63 paroxysmal, 37 persistent) were enrolled. The isolation of the PVs was performed by wedging the balloon at each PV antrum to create circumferential lesions in each case. Contiguous linear lesions were also created at the roof between the superior PVs and at the bottom of the posterior LA between the inferior PVs by dragging the balloon along the endocardium.Complete elimination of the posterior LA and PV potentials was achieved in all 100 cases, confirmed by either conventional or electro-anatomic mapping system. The total procedure time was 129Ϯ26 minutes, inclusive of 29.9Ϯ7.3 minutes of fluoroscopy time. Follow-up during 11.0Ϯ4.8 months confirmed that 92 patients (60 paroxysmal, 32 persistent) were free from atrial fibrillation without antiarrhythmic drugs, and in the remaining patients except for 2 with LA tachycardia, sinus rhythm was maintained with antiarrhythmic drugs. With precautions of esophageal cooling by irrigation dictated by temperature monitoring and monitoring phrenic nerve pacing, no LA-esophageal fistula or permanent phrenic nerve injury occurred. Conclusion-This

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…706 A central electrode delivers RF energy to the saline in the balloon, and a unique mixing system creates turbulent flow, promoting uniform distribution of the heated saline throughout the balloon. The balloon surface directly heats the PV wall circumferentially.…”

Hot balloon ablation of persistent atrial fibrillation with a dilated left atrium in a case of dilated cardiomyopathy

“…[3] The independent predictor of AF recurrence was heart failure with preserved ejection fraction (EF). [4,5] In a previous study, [4] 92 patients were free from AF (60 paroxysmal, 32 persistent), but cases with severe heart failure and a dilated left atrium (> 55 mm) were excluded. However, in the present case, the patient developed decompensated heart failure with severe LV dysfunction, and hot balloon ablation was effective for congestive heart failure with a giant left atrium.…”

“…On the other hand, it has been reported that the time of isolation can be shorter with balloon ablation than with CA; [1,2] therefore, the intravenous drip volume is small. [3][4][5] We decided to use the balloon technique for a patient with LA dilatation and severe LV dysfunction.…”

The Future of Pulmonary Vein Isolation – Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation?

“…23 More anecdotal is the use of the RF hot balloon catheter (Hayama Arrhythmia Institute, Kanagawa, Japan) based on RF delivery between a coil electrode inside the balloon and the four cutaneous electrode patches on the patient's back to induce capacitive-type heating of the balloon. 39,40 The technique allows isolation of the PV and posterior left atrium. No major collateral complications have been reported and the incidence of transient right phrenic nerve palsy was only 1 % in the largest series to date.…”

“…No major collateral complications have been reported and the incidence of transient right phrenic nerve palsy was only 1 % in the largest series to date. 40 However, the lack of multicentre studies and limited follow-up do not allow to fully evaluate the efficacy of the RF hot balloon catheter for the treatment of AF.…”