Key result
The energy-guided short-duration protocol significantly reduced total time in the pulmonary vein compared to the default protocol (43.0 vs 61.1 min, p<0.0001) without increasing arrhythmia recurrence.
Why the study?
Laser balloon-based pulmonary vein isolation lesion size depends on laser energy, but the default protocol is not energy-based, leading to the hypothesis that an energy-guided short-duration protocol could shorten procedure time without compromising efficacy and safety.
Does an energy-guided short-duration protocol reduce procedure time and energy delivery without affecting efficacy and safety compared to the default protocol in patients undergoing laser balloon-based pulmonary vein isolation for atrial fibrillation?
Observational (n=52)
Does an energy-guided short-duration protocol reduce procedure time and energy delivery without affecting efficacy and safety compared to the default protocol in patients undergoing laser balloon-based pulmonary vein isolation for atrial fibrillation?
An energy-guided short-duration protocol for laser balloon-based pulmonary vein isolation significantly reduces procedure time and energy delivery without compromising safety or mid-term efficacy.
May shorten ablation times safely in feasibility testing; leaves open efficacy in randomized trials.
BACKGROUND: Laser balloon-based pulmonary vein isolation (LB-PVI) is available for atrial fibrillation (AF) ablation. The lesion size depends on laser energy; however, the default protocol is not an energy-based setting. We hypothesized that an energy-guided (EG) short-duration protocol may be an alternative to shorten the procedure time without affecting efficacy and safety. METHODS: We evaluated the efficacy and safety of the EG short-duration protocol (EG group) (target energy 120 J/site [12W/10s; 10W/12s; 8.5W/14s; 5.5W/22s]) compared with the default protocol (control group) (12W/20s; 10W/20s; 8.5W/20s; 5.5W/30s). RESULTS: A total of 52 consecutive patients (EG: n = 27 [103veins] and control: n = 25 [91veins]) undergoing LB-PVI (64 ± 10 years, 81% male, 77% paroxysmal) were enrolled. The EG group had a shorter total time in the pulmonary vein (PV) (43.0 ± 13.9 min vs. 61.1 ± 16.0 min, p < .0001), a shorter total laser application time (1348 ± 254 sec vs. 2032 ± 424 sec, p < .0001), and lower total laser energy (12455 ± 2284J vs. 18084 ± 3746J, p < .0001). There was no difference in the total number of laser applications (p = 0269) or first-pass isolation (p = .725). Acute reconduction was identified only in one vein in the EG. No significant differences were observed in the incidence of pinhole rupture (7.4% vs. 4%, p = 1.000) or phrenic nerve palsy (3.7% vs. 12%, p = .341). During a mean follow-up of 13.5 ± 6.1 months, Kaplan-Meier analysis revealed no significant difference in atrial tachyarrhythmia recurrence (p = .227). CONCLUSION: LB-PVI with the EG short-duration protocol may be achieved in a shorter procedure time to avoid deterioration of efficacy and safety. The EG protocol is feasible as a novel point-by-point manual laser-application approach.
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Sano et al. (2023) conducted an observational in Atrial fibrillation (n=52). Energy-guided short-duration protocol for laser balloon-based pulmonary vein isolation vs. Default protocol was evaluated on Total time in the pulmonary vein (PV) in minutes (p=<.0001). The energy-guided short-duration protocol significantly reduced total time in the pulmonary vein compared to the default protocol (43.0 vs 61.1 min, p<0.0001) without increasing arrhythmia recurrence.
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