Key result
Laser balloon ablation matches irrigated radiofrequency ablation for freedom from atrial tachyarrhythmia in initial AF.
Why the study?
Laser balloon ablation was introduced to simplify conventional radiofrequency ablation for atrial fibrillation, but comparative study results regarding efficacy and safety remained controversial.
Does laser balloon ablation improve freedom from atrial tachyarrhythmia and reduce complications compared to irrigated radiofrequency ablation as initial therapy in patients with atrial fibrillation?
Meta-Analysis (n=1,274)
Does laser balloon ablation improve freedom from atrial tachyarrhythmia and reduce complications compared to irrigated radiofrequency ablation as initial therapy in patients with atrial fibrillation?
Effect estimate: OR 1.26 (95% CI 0.95-1.67)
Absolute Event Rate: 72.5% vs 68.7%
p-value: p=0.111
Laser balloon ablation and irrigated radiofrequency ablation demonstrate comparable efficacy and overall safety for initial atrial fibrillation ablation, though laser balloon ablation is associated with fewer pulmonary vein reconnections but higher rates of phrenic nerve palsy.
Comparable efficacy and safety support either modality for initial AF ablation; confirms equivalence in meta-analysis.
Background: Catheter ablation (CA) is an effective therapy for atrial fibrillation (AF) and, although radiofrequency ablation (RFA) is the standard treatment for pulmonary vein isolation (PVI), it is complex and time-consuming. Laser balloon ablation (LBA) has been introduced to simplify the conventional RFA; however, results of studies comparing LBA and RFA remain controversial. As such, this investigation aimed to comprehensively evaluate the efficacy and safety of LBA versus RFA. Methods: The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for relevant studies. The primary endpoints were the freedom from atrial tachyarrhythmia (ATA) and procedure-related complications. Results: Twelve studies including 1274 subjects were included. LBA and RFA yielded similar rates of freedom from ATA (72.5% vs. 68.7%, odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.0–1.7, p = 0.11) and procedure-related complications (7.7% vs. 6.5%, OR = 1.17, 95% CI 0.72–1.90, p = 0.536). LBA with the second- and third-generation laser balloons (LB2/3) yielded remarkably higher rates of freedom from ATA than RFA using contact-force technology (RFA-CF) (OR = 1.91, p = 0.013). Significantly lower pulmonary vein (PV) reconnection rates (OR = 0.51, p = 0.021), but higher phrenic nerve palsy (PNP) rates (OR = 3.42, p = 0.023) were observed in the LBA group. LBA had comparable procedure (weighted mean difference [WMD] = 8.43 min, p = 0.337) and fluoroscopy times (WMD = 3.09 min, p = 0.174), but a longer ablation time (WMD = 12.57 min, p = 0.00) than those for RFA. Conclusions: LBA and RFA treatments were comparable in terms of freedom from ATA and postprocedural complications in patients with AF. Compared with RFA, LBA was associated with significantly lower PV reconnection rates, but a higher incidence of PNP and longer ablation time.
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Chen et al. (2024) conducted a meta-analysis in Atrial Fibrillation (n=1,274). Laser balloon ablation vs. Irrigated radiofrequency ablation was evaluated on Freedom from atrial tachyarrhythmia (ATA) (OR 1.26, 95% CI 0.95-1.67, p=0.111). Laser balloon ablation and irrigated radiofrequency ablation yielded comparable rates of freedom from atrial tachyarrhythmia (72.5% vs. 68.7%, OR 1.26) as initial therapies for atrial fibrillation.
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