Abstract 2862: Does Visually-Guided Placement of Contiguous Ablation Lesions Result in Reliable and Persistent Pulmonary Vein Isolation?
Background: While conceptually straightforward, placing point-to-point contiguous radiofrequency lesions to achieve pulmonary vein isolation (PVI) is technically challenging. After placing encircling lesions, additional lesions are often needed to achieve PVI. Also, chronic efficacy is limited by late PV reconnections. A novel compliant balloon ablation catheter (BAC) able to deliver visually-guided short arcs of laser energy was tested to determine if visual guidance could predict reliable and persistent PVI.
Methods: The BAC is equipped with an endoscope to allow real-time visualization of the PV junction during ablation with a short 30° adjustable arc of laser energy (980nm). The BAC was placed at the PV ostia under ICE guidance. Under direct visualization, lesions were placed in an overlapping manner. PVs were reassessed for isolation after 30 min. Pre-specified PV remapping was scheduled at 8 wks to assess for persistent PVI.
Results: The study included 18 PAF patients with a total 65 PVs (7 common PVs). After the initial encircling lesion set, 57/65 (88%) PVs were isolated; additional ablations isolated the remaining PVs. Only one balloon/pt was required in 17 pts; the remaining pt required 2 balloons. The mean case duration was 233 min (range 174 –365, mean ablation time was 63.7 min/case, and mean fluoroscopy time was 20.7 min/case (range 11.9 –35.8). All PVs remained isolated after 30 min; there were no complications. At 8 weeks, 10/18 pts underwent remapping and 36/38 (95%) PVs remained isolated.
Conclusions: Visually-guided electrical PV isolation using a variable radius endoscopic laser balloon is feasible, reliable, and persistent.