Clin Res Cardiol 101, Suppl 1, April 2012

V1168 - High Dose versus Low Dose Laser Balloon Ablation for Pulmonary Vein Isolation
B. Schmidt1, M. Gunawardene1, S. Bordignon2, M. Kulikoglu3, V. Urban1, B. Schulte-Hahn1, B. Nowak1, K. R. J. Chun1
1Cardioangiologisches Centrum Bethanien - CCB, Frankfurt am Main; 2Dipartimento di Scienze Cardiologiche, Toraciche, Vascolari, Università degli studi di Padova, Padova, Italien; 3Markus Krankenhaus, Frankfurt am Main;
Background: As recently demonstrated pulmonary vein (PV) occlusion predicts successful acute PV isolation (PVI) using the endoscopic ablation system (EAS). Little data exists on energy titration and its influence on lesion formation. Therefore we sought to determine the effect of different ablation energy protocols on acute and chronic procedural success
Methods: Patients with drug-refractory atrial fibrillation were treated with EAS in two groups. In the low-dose group (LD) energy was kept at 5.5W to 8.5 W and in the high-dose group (HD) energy was titrated to 10-12W after obtaining optimal PV occlusion with the balloon catheter. In group LD ablation energy of >8.5 W was exceptionally permitted in case of optimal contact at the anterior LPV ostium. After single transseptal puncture and baseline PV angiographies sequential PVI was performed solely based on visual guidance. Post ablation PV recordings with a circular mapping catheter (CMC) were compared with baseline recordings. The acute primary endpoint was the number of isolated PVs after purely visually guided ablation. In case of residual LA-PV conduction gap ablation was guided by CMC activation sequence using EAS. Follow-up was carried out using transtelefonic monitoring and 3 days Holter ECGs after 3, 6 and 12 months for the chronic primary endpoint of freedom from AF off antiarrhythmic drugs.
Results: In each group 30 patients were enrolled (30 male; mean age 63±9 years). In total, 234 PVs (6 LCPVs) were treated and ultimately isolated using EAS. After pure visual guidance 82/118 PVs (69%; LD) and 103/116 PVs (89%; HD) were isolated (p=0.004; OR 3.5). In group HD 75% of all applications were carried out with >8.5W as opposed to 15% in group LD (p<0.0001; Chi square). In group HD less applications/PV were required (32±8 versus 35±15; p=0.03) but total ablation energy was higher (6483±1834 versus 5306±2258Ws; p=0.004). Procedure times were significantly shorter in group HD (154±38 versus 128±17;p=0.001). In both groups one phrenic nerve palsy was observed. Importantly, no atrial-to-esophageal fistula or thrombembolic complications were observed. During median follow-up of 190 days, 7/30 (23%;LD) and 3/30 (10%;HD) had a documented AF recurrence off AAD.
Conclusion: Laser balloon ablation using a HD protocol appears to be associated with a similar safety profile but with a 3.5 fold higher chance to achieve acute PVI after a single visually guided PV encircling ablation. This leads to shorter procedure times. Mid term success rate seems promising but longer FU is needed.
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6