Key result
Laser balloon ablation is associated with ~95% less acute PV wall thickening than radiofrequency ablation.
Why the study?
Thermally induced cardiac lesions cause tissue changes visible on ultrasound, motivating the use of ICE to evaluate pulmonary vein tissue morphology and acute tissue changes following RF or laser ablation for AF.
Does laser balloon ablation compared to irrigated radiofrequency ablation result in different acute tissue changes in patients with atrial fibrillation undergoing pulmonary vein isolation?
Observational (n=27)
Does laser balloon ablation compared to irrigated radiofrequency ablation result in different acute tissue changes in patients with atrial fibrillation undergoing pulmonary vein isolation?
Compared with laser balloon ablation, radiofrequency ablation for atrial fibrillation results in markedly more acute pulmonary vein wall thickening with significant regional variations as measured by intracardiac echocardiography.
Laser balloon was associated with less acute PV wall thickening than RF; hypothesis-generating for tissue effects, needs randomized validation.
INTRODUCTION: Thermally induced cardiac lesions result in necrosis, edema, and inflammation. This tissue change may be seen with ultrasound. In this study, we sought to use intracardiac echocardiography (ICE) to evaluate pulmonary vein tissue morphology and assess the acute tissue changes that occur following radiofrequency (RF) or laser ablation for atrial fibrillation (AF). METHODS AND RESULTS: Patients with AF underwent pulmonary vein isolation (PVI) using irrigated RF or laser balloon. Pre- and post-ablation ICE imaging was performed from within each pulmonary vein (PV). At least 10 transverse imaging planes per PV were evaluated and each plane was divided into eight segments. The PV/atrial wall thickness and the luminal area were measured at each segment. Twenty-seven patients underwent PVI (15 with laser, 12 with RF). Ninety-eight pulmonary veins were analyzed (58 PVs laser; 40 PVs RF). At baseline, there were no regional differences in PV wall thickness in the right-sided veins. The anterior regions of left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV) were significantly thicker compared with the posterior and inferior regions (p < .01). Post-ablation, PV wall thickness in RF group increased 24.1% interquartile range (IQR) (17.2%-36.7%) compared with 1.2% IQR (0.4%-8.9%) in laser group, p = .004. In all PVs, RF ablation resulted in significantly greater percent increase in wall thickness compared with laser. Additionally, RF resulted in more variable changes in regional PV wall thickness; with more increases in wall thickness in anterior versus posterior LSPV (75.4 ± 58.5% vs. 46.8 ± 55.6%, p < .01), anterior versus posterior right superior pulmonary vein (RSPV) (62.9 ± 63.9% vs. 44.6 ± 51.7%, p < .05), and superior versus inferior RSPV (69.1 ± 45.4% vs. 35.9 ± 45%, p < .05). There were no significant regional differences in PV wall thickness changes for the laser group. CONCLUSIONS: Rotational ICE can be used to measure acute tissue changes with ablation. Regional variability in baseline wall thickness was nonuniformly present in PVs. Acute tissue changes occurred immediately post-ablation. Compared with laser balloon, RF shows markedly more thickening post-ablation with significant regional variations.
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Gao et al. (2021) conducted an observational in Atrial fibrillation (n=27). Laser balloon ablation vs. Irrigated radiofrequency (RF) ablation was evaluated on Percent increase in pulmonary vein wall thickness post-ablation (p=0.004). Laser balloon ablation resulted in a significantly smaller acute increase in pulmonary vein wall thickness compared with radiofrequency ablation (1.2% vs 24.1%, p=0.004).
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