Key result
The incidence of mild pulmonary vein stenosis was highest after laser balloon ablation (18.4%) and lowest after cryoballoon ablation (3.6%) compared to radiofrequency ablation (9.5%), with no severe stenosis observed.
Why the study?
Does the choice of ablation energy (radiofrequency, cryoballoon, or laser balloon) affect the incidence of pulmonary vein stenosis in patients undergoing atrial fibrillation ablation?
Cohort (n=344)
No
Does the choice of ablation energy (radiofrequency, cryoballoon, or laser balloon) affect the incidence of pulmonary vein stenosis in patients undergoing atrial fibrillation ablation?
Absolute Event Rate: 18.4% vs 9.5%
p-value: p=<0.01
Contemporary atrial fibrillation ablation using radiofrequency, cryoballoon, or laser balloon is associated with a very low risk of significant pulmonary vein stenosis, though mild narrowing is most frequently observed with laser balloon ablation.
Supports very low significant PVS risk with contemporary AF ablation; leaves open whether laser balloon increases mild narrowing.
BACKGROUND: The incidence of pulmonary vein stenosis (PVS) after AF ablation following contemporary procedures remains unclear. We compared the incidence of PVS/narrowing (PVS/N) after PV isolation (PVI) for (1) 3-D mapping-guided wide-area encircling irrigated radiofrequency current (RFC) ablation; (2) first-third-generation big cryoballoon (CB1-3) ablation; and (3) laser balloon (LB) ablation. METHODS AND RESULTS: All patients undergoing a second procedure between January 2012 and November 2016 were subgrouped according to index ablation (PVI): RFC; CB; or LB. PVS/N was classified using PV diameter ratio (second/index procedure) on selective PV angiogram performed before ablation: mild, 25-49%; moderate, 50-74%; or severe, ≥75%. A total of 344 patients (1,362 PV) were analyzed (RFC, n=211; 840 PV; CB1, n=21; 82 PV; CB2,3, n=64; 250 PV; LB, n=48; 190 PV). In the LB group, 45 patients (94%) were treated with dose ≥8.5 W. Second procedures were performed on average 14.9±14.1 months after the index procedure. Mild PVS/N was observed in 18.4%, 9.5% and 3.6% of PV in the LB, RFC and CB groups, respectively (P<0.01). Moderate PVS was recognized in 2 PV (0.1%; RFC, LB). Severe PVS was never observed, and no PV intervention/surgery was required. CONCLUSIONS: The risk for significant PVS is low after RFC/CB. The incidence of mild PVS/N was highest after standard-dose LB ablation and lowest after high-dose CB ablation.
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Nagase et al. (2018) conducted a cohort in Atrial fibrillation (n=344). Laser balloon (LB) and big cryoballoon (CB) ablation vs. Irrigated radiofrequency current (RFC) ablation was evaluated on Incidence of mild pulmonary vein stenosis/narrowing (25-49%) per pulmonary vein (p=<0.01). The incidence of mild pulmonary vein stenosis was highest after laser balloon ablation (18.4%) and lowest after cryoballoon ablation (3.6%) compared to radiofrequency ablation (9.5%), with no severe stenosis observed.
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