What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=152). Intervention: Visually guided laser balloon (VGLB) ablation. Primary outcome: Freedom of AF or AT during long-term follow-up.

April 15, 2023Open Access

Pulmonary vein isolation by visually guided laser balloon ablation: single-center 5-year follow-up results

Key Result

First-generation visually guided laser balloon ablation for atrial fibrillation resulted in a 74.3% freedom from atrial fibrillation over a median follow-up of 51 months.

Study Design

Type

Observational (n=152)

Multicenter

Structured PICO

Does visually guided laser balloon ablation prevent arrhythmia recurrence in patients with paroxysmal or persistent atrial fibrillation?

Population

152 patients with paroxysmal (62.5%) or persistent (37.5%) atrial fibrillation, mean age 60.6 ± 9.7 years, 72.4% male, treated at a single center in Belgium.

Intervention

Pulmonary vein isolation (PVI) using the first-generation visually guided laser balloon (VGLB) system (HeartLight Endoscopic Ablation System).

Outcome

Freedom of atrial fibrillation (AF) or atrial tachycardia (AT) during long-term follow-up.composite

First-generation visually guided laser balloon ablation for pulmonary vein isolation demonstrates high acute success, low complication rates, and sustained long-term freedom from atrial fibrillation at 5 years.

Limitations

Retrospective, single-center design
Long-term follow-up was left to referring cardiologists rather than standardized with implantable devices
Left atrial volume data were not available for many patients
Non-pulmonary vein triggers during the index procedure were not treated
Only evaluated the first-generation VGLB catheter

Abstract

BACKGROUND: Visually guided laser balloon (VGLB) ablation is a balloon-based treatment for atrial fibrillation (AF) that uses a titratable laser energy source to perform pulmonary vein isolation (PVI), allowing for real-time visualization of target tissue and ablation lesions through an endoscopic camera. Few long-term data on this technique are currently available. This report presents acute efficacy, procedural data, complication rates, and long-term AF-free survival up to 5 years post-ablation. METHODS: In this single-center, retrospective, observational report, 152 patients (72.4% male, mean age 60.6 ± 9.7 years, 62.5% paroxysmal AF, 598 pulmonary veins in total) treated with the first-generation VGLB system between 2014 and 2016 were included for analysis. AF ablation consisted of PVI only. RESULTS: IQR 3603-8711 were recorded. During a median follow-up of 51 months IQR 45-57, 74.3% of patients remained free of AF (78.8% for paroxysmal and 65.3% for persistent AF, p = 0.108). Freedom of AF at 1, 2, 3, and 4 years follow-up was 88.2%, 82.2%, 78.9%, and 74.8%, respectively. PV reconnections were identified in only 46.9% of redo procedures. The median number of PV reconnections during redo procedures was 0 IQR 0-2. Anti-arrhythmic drug use was significantly reduced after ablation (p < 0.001). The most commonly reported complications were minor vascular complications (4.6%) and transient phrenic nerve paralysis (3.3%). CONCLUSIONS: First-generation VGLB ablation demonstrated high acute isolation rates, reasonable procedure times and low complication rates. Long-term freedom from AF was 78.8% for paroxysmal AF and 65.3% for persistent AF, performing PVI only.

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