The study was supported by a research grant of CardioFocus, Marlborough, MA, USA.
Visually Guided Sequential Pulmonary Vein Isolation: Insights into Techniques and Predictors of Acute Success
Article first published online: 9 JAN 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 6, pages 576–582, June 2012
How to Cite
SCHMIDT, B., GUNAWARDENE, M., URBAN, V., KULIKOGLU, M., SCHULTE-HAHN, B., NOWAK, B., BORDIGNON, S. and CHUN, K. J. (2012), Visually Guided Sequential Pulmonary Vein Isolation: Insights into Techniques and Predictors of Acute Success. Journal of Cardiovascular Electrophysiology, 23: 576–582. doi: 10.1111/j.1540-8167.2011.02247.x
Drs. Schmidt and Chun received speaker's bureau fees from CardioFocus. Other authors: No disclosures.
- Issue published online: 11 JUN 2012
- Article first published online: 9 JAN 2012
- Manuscript received 2 Septemper 2011; Revised manuscript received 13 October 2011; Accepted for publication 9 November 2011.
- atrial fibrillation;
- laser balloon;
- pulmonary vein isolation
Sequential PVI with Laser Balloon. Introduction: Pulmonary vein isolation (PVI) is a challenging procedure most often requiring sophisticated technical aids such as electroanatomical mapping, double transseptal access, and the use of a circular mapping catheter. We sought to develop a PVI strategy solely based on visual guidance with a single ablation device as well as a single transseptal puncture using the endoscopic ablation system (EAS).
Methods and Results: In 35 patients with drug-refractory atrial fibrillation (18 male, mean age: 62 ± 9 years) ablation was performed. PVI was achieved in 96 of 137 PVs (70%) purely by visually guided circular ablation. Predictors of acute isolation were the degree of PV occlusion by EAS as well as the number of catheter repositionings but not total ablation energy or the number of laser applications. Conduction gaps were detected at sites with suboptimal occlusion as well as esophageal temperature elevations. Further EAS ablation resulted in a 98% acute isolation rate. Mean procedure and fluoroscopy times were 154 ± 38 minutes and 16 ± 6 minutes, respectively. Between the first and last 12 cases, a reduction in procedure times (175 ± 48 minutes vs 138 ± 26 minutes; P = 0.05) was observed. One pericardial tamponade and 1 right-sided phrenic nerve palsy occurred. During a median follow-up of 266 days (q-q3: 218–389), 27 of 35 patients (77%) remained free of any tachyarrhythmia recurrence off antiarrhythmic drugs.
Conclusions: Sequential PVI based solely on endoscopic visual information with a single device and a single transseptal puncture is feasible. Optimal PV occlusion and few controlled repositionings facilitate PVI. (J Cardiovasc Electrophysiol, Vol. 23, pp. 576–582, June 2012)