Acute efficacy and clinical outcomes using HotBalloon for pulmonary vein isolation in patients with a left common pulmonary vein

INTRODUCTION: HotBalloon material is compliant and the balloon size can be enlarged by increasing the intraballoon injection volume. HotBalloon-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF), however, the acute efficacy and clinical outcomes of the HotBalloon-based PVI have never been fully investigated in patients with a left common pulmonary vein (LCPV). METHODS AND RESULTS: One hundred fifty-three PAF patients underwent HotBalloon-based PVI. Three-dimensional computed tomography was performed in all patients before the ablation. An LCPV was observed in 40 (26%) patients. For HotBalloon ablation of an LCPV, in patients with an LCPV of superoinferior diameter <34 mm, the left common ostium was preferably isolated if sufficient occlusion could be achieved. In patients with an LCPV diameter ≥34 mm, left superior and inferior branches of the LCPV were targeted individually. The number of HotBalloon applications in patients with LCPV was significantly smaller than without LCPV (7.3 ± 2.0 vs 8.1 ± 2.1; P = .04). In patients with LCPV diameter <34 mm, 75% of LCPVs successfully achieved full balloon occlusion (50% were isolated by application at the LCPV ostium alone, 25% by application at the LCPV ostium followed by either superior or inferior LCPV branch ablation) and 25% were isolated individually. One year after a single session, the arrhythmia-free rates were similar between patients with and without LCPV (77% vs 74%, log rank, P = .86). CONCLUSIONS: HotBalloon-based PVI delivers long-term favorable success rates with fewer HotBalloon applications in paroxysmal AF patients with an LCPV.