Rapid pulmonary vein isolation utilizing the third-generation laserballoon – The PhoeniX registry

Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

“…Recent studies utilizing the cryoballoon reported mean procedure times of 114–140 min when omitting a bonus-freeze cycle [18] , and 77–96 min when using individualized energy titration protocols [19] , [20] , [21] . For the latest generation laser balloon, 77 min of median procedure time where reported [22] . Although a comparable procedure time of 55.6 ± 6.6 min for PVI only was reported for the 50 W power-controlled HP-SD protocol suggested by Chen et al [10] in our series 29% of patients received additional CTI block, 18% received a roof line and 7% an anterior line ablation.…”

Clinical Applications of Laser Technology: Laser Balloon Ablation in the Management of Atrial Fibrillation

“…The overall procedural safety was comparable to earlier generations of the device, with potentially lower occurrence of phrenic nerve injury [ 31 ]. In a prospective study comparing the 2nd (LB2) and 3rd generation (LB3) LBA systems, Heeger et al [ 32 ] demonstrated significant reductions in total procedure time (LB2: 91 (IQR: 86, 105) min vs. LB3: (77 (IQR: 68, 87) min; p < 0.001) and laser ablation time (LB2: 1920 (IQR: 1765, 2193) s vs. LB3: 1077 (896, 1165) s; p < 0.000001) without difference in occurrence of major adverse events (LB2: 1/15 (6.7%) vs. LB3: 1/15 (6.7%); p = 0.999). Further, while pulmonary vein diameter, shape, and branching can adversely affect AF-free survival with CB PVI ablation [ 33 , 34 ], PV anatomy does not seem to hold similar negative impact on clinical outcomes for LBA, particularly as the introduction of LB2 system, because of the compliant, adjustable sized balloon design which confirms readily to most PV anatomy [ 35 ].…”

Evaluation of different ablation strategies verifying the optimal overlap ratio in point-by-point laser balloon ablation for patients with atrial fibrillation

“…However, point-by-point laser ablation is also required even with LB3 in substantial cases because of esophageal temperature rise or difficult PV occlusion. 6 In point-by-point LB ablation, 30 to 50 % overlapped ablation with high power (8.5W or more) is recommended for high rate of first-pass PVI (i.e., successful PVI after the initial circular [first-pass] LB ablation) using the attached software (LightTrack, CardioFocus). 4,5,7,8 However, no specific overlap ratio for acute and durable PVI has been clarified.…”

“…2 , 3 At present, the first-generation LB (LB1) (HeartLight; CardioFocus, Marlborough, MA), the second-generation LB (LB2) (HeartLight Excalibur Balloon; CardioFocus), and the third-generation LB (LB3) (HeartLight X3; CardioFocus) are available. 2 , 3 , 4 , 5 , 6 With LB1 and LB2, laser is basically titrated in a point-by-point fashion with the power settings of 5.5–12 W. LB3 is newly equipped with an additional motorized rotational delivery system (RAPID mode) with higher power (13 W or 15 W) to reduce the procedure time. However, point-by-point laser ablation is also required even with LB3 in substantial cases because of esophageal temperature rise or difficult PV occlusion.…”

“…However, point-by-point laser ablation is also required even with LB3 in substantial cases because of esophageal temperature rise or difficult PV occlusion. 6 …”