Abstract 10208: Quantitative Comparison of Ablation Area Created by the Conventional- and Larger-Sized Visually Guided Laser Balloon

Abstract

Introduction: The visually guided laser balloon (VGLB) ablation catheter has been designed to facilitate pulmonary vein (PV) isolation in patients with atrial fibrillation (AF). Because VGLB is characterized by a compliant and variable diameter balloon, the balloon at the larger inflation size can isolate wider-area circumferential PV antrum. Though the importance of a wider circumferential isolation of PVs, which includes a large portion of the left atrial posterior wall (LAPW), has been suggested in several studies, the extension of the isolation area created by the new VGLB technique remains to be elucidated. We report the quantitative examination of the isolation areas after the conventional- and larger-sized VGLB ablation. Methods: Fifty-five patients with AF who underwent VGLB ablation were enrolled in this prospective study. An electroanatomic map of the left atrium was obtained with the PENTARAY catheter and the CARTO-3 system before and after PV isolation using conventional-sized VGLB. The isolation areas were extended by the larger-sized VGLB ablation and remapped in the same way. As demonstrated in figure, the isolation areas were measured after each ablation. Results: After PV isolation using the conventional-sized VGLB, the mean left- and right-sided antral PV surface areas of ablation were 13.5±2.9 cm 2 and 16.4±3.7 cm 2 , respectively. The total area of LAPW ablation was 10.9±2.1 cm 2 (45.6±9.3% of the posterior wall). On the other hand, they were 18.6±4.0 cm 2 , 23.7±5.2 cm 2 and 16.3±2.8 cm 2 (65.9±11.2%) after ablation with the larger-sized VGLB. These results revealed that the new VGLB technique yielded statistically greater areas of isolation than the conventional-sized VGLB. Conclusions: The larger VGLB ablation technique can create a significantly wider antral PV and LAPW isolation than the conventional-sized VGLB. The resulting LAPW debulking may be greater than the other balloon-based ablation lesions that have been reported previously.