Second-generation laser balloon ablation for the treatment of atrial fibrillation assessed by continuous rhythm monitoring: the LIGHT-AF study

Abstract

Aims Balloon-based technologies have been developed to simplify catheter ablation of atrial fibrillation (AF), to improve the clinical outcome of the procedure and to achieve durable pulmonary vein isolation (PVI). The objective of this study is to evaluate the safety and efficacy of second-generation laser balloon (LB2) ablation in the treatment of AF using a continuous cardiac rhythm monitoring strategy. Atrial tachyarrhythmias (ATas) recurrences were assessed with implantable cardiac monitors (ICMs) or devices. Methods and results All patients underwent LB2 ablation procedure. The primary endpoint was the first recurrence of any, >5.5 and >24 h duration ATas after the blanking period (90 days). In-hospital visits were performed at 3, 6, and 12 months. Seventy-three patients (68% male, mean age 59.8 ± 11.3) were included in the study. The average procedure, fluoroscopy, and laser ablation times were 81.5 ± 30.1, 21.5 ± 12.4, and 33.8 ± 9.7, respectively. All PVs were isolated using the LB2 with no need of touch-up using focal catheters. No major complications occurred during or after the procedures. The one-year freedom from recurrences was 66.9% (95% CI: 57.0–76.7%), 81.0% (69.5–88.5%), and 86.8% (76.1–92.9%) considering any, 5.5-h and 24-h cut-off duration, respectively. At 3, 6, and 12 months, any ATas was recorded in 22%, 32%, and 25% of patients, with a ≥5% arrhythmic burden documented in 4%, 5%, and 3%, respectively. Few patients reported AF-related symptoms (7%, 8%, and 5%). Conclusion LB2 ablation is a safe and effective procedure, showing a high freedom from recurrences and low arrhythmic burden as documented by a continuous rhythm monitoring strategy.

Evaluation of linear lesion formation and thermodynamics by dragging ablation with the third-generation laser balloon

“…Therefore, a 30%–50% overlap ratio is recommended in point-by-point laser ablation. 6 , 8 , 9 However, because lesion size could depend on both power and total laser energy, 19 30% overlapped point-by-point laser ablation may create conduction gaps on linear lesions depending on laser power or energy. Recently, we reported that 50% overlapped laser ablation enabled a higher rate of first-pass PVI (ie, successful PVI after the initial circular laser ablation) than 25% overlapped laser ablations.…”

“…6 , 7 The laser balloon catheter has recently evolved to the latest version, the third-generation laser balloon (LB3) (HeartLight X3; CardioFocus, Marlborough, MA) from the first-generation laser balloon (LB1) (HeartLight; CardioFocus) and second-generation laser balloon (LB2) (HeartLight Excalibur Balloon; CardioFocus). 6 , 7 , 8 , 9 , 10 , 11 LB1 and LB2 are generally point-by-point ablation systems, leading to relatively long procedural times. 6 , 7 , 8 , 9 LB3 is newly equipped with a motorized rotational delivery system (RAPID mode) with high power (13 W or 15 W), resulting in a prominent reduction in procedural time compared with LB1 and LB2.…”

“…6 , 7 , 8 , 9 , 10 , 11 LB1 and LB2 are generally point-by-point ablation systems, leading to relatively long procedural times. 6 , 7 , 8 , 9 LB3 is newly equipped with a motorized rotational delivery system (RAPID mode) with high power (13 W or 15 W), resulting in a prominent reduction in procedural time compared with LB1 and LB2. 10 , 11 However, there have been no quantitative reports on the size and continuity of linear lesion and thermodynamics exerted on the tissues by LB3.…”

Acoustic energy and cardiac electrophysiology: Ultrasonic cardiac pacing and novel shockwave ablation catheters

“…The single-arm study LIGHT-AF demonstrated the safety and efficacy of this procedure with a high freedom from recurrences and a low arrhythmic burden in patients who experienced recurrences. 46 Also, a group of investigators based in Japan developed a novel shockwave catheter ablation system, aiming to surpass the limitations of radiofrequency ablation. [47][48][49] They tested the shockwave system on pigs and found a superiority to radiofrequency in lesion depth, myoendocardial injury, and tissue repair.…”

“…In addition, the visually guided laser ballon (VGLB; LB1, HeartLight, CardioFocus, Marlborough, MA, USA) is a new effective technique to achieve pulmonary vein isolation. The single‐arm study LIGHT‐AF demonstrated the safety and efficacy of this procedure with a high freedom from recurrences and a low arrhythmic burden in patients who experienced recurrences 46 . Also, a group of investigators based in Japan developed a novel shockwave catheter ablation system, aiming to surpass the limitations of radiofrequency ablation 47–49 .…”