B-PO04-100 A PROSPECTIVE, MULTICENTER COMPARISON OF RADIOFREQUENCY, CRYOBALLOON, AND LASER BALLOON ABLATION FOR PULMONARY VEIN ISOLATION IN PATIENTS WITH ATRIAL FIBRILLATION: ACUTE PROCEDURAL FINDINGS

Abstract

Pulmonary vein isolation (PVI) ablation is a cornerstone treatment for patients with atrial fibrillation (AF). In a prospective multicenter study, we examined acute procedural outcomes across three modalities, radiofrequency (RF), cryoballoon (CB) and laser balloon (LB), in AF patients. A multicenter registry (2 U.S. centers) of prospectively collected acute procedural data. Procedure time was defined as: initial groin puncture to ablation catheter withdrawal from left atrium (LA). LA treatment time: transseptal puncture to catheter withdrawal from LA. Total therapy time: time from first to last energy application for RF, time from first freeze to end of last thaw for CB, time laser was active for LB. Additional ablation attempts was defined as: periprocedural reconnection for RF, each additional freeze after initial and one bonus freeze for CB, and each additional lesion set after failed initial PVI attempt for LB. 808 AF patients underwent RF (n=239), CB (n=278) and LB (n=291) ablation. In the cohort, PVI was performed using high power short duration (33.1%; HPSD) and non-HPSD (66.8%) RF, 2nd (36.4%) and 3rd (63.6%) generation CB catheters, and 1st (3.1%; Classic), 2nd (43.6%; Excalibur), and 3rd (53.3%; X3) generation LB catheters. Mean age was 65.7 (RF), 66.9 (CB) and 63.2 (LB). 72.4% of RF, 57.6% of CB, and 68.6% for LB (n=277) were male. Paroxysmal AF was present in 52.7% of RF, 59.7% of CB, and 68.8% of LB patients. Procedure time was 130 +/- 42 min for RF, 97 +/- 34.5 for CB, and 118 +/- 46 min for LB. LA treatment time was 105 +/- 35 min for RF, 90 +/- 13 min for CB, and 93 +/- 29 min for LB. Fluoroscopy times were 10.1 +/- 5.5 min, 14.6 +/- 6.9 min, and 9.8 +/- 6.6 min for RF, CB and LB, respectively. Total therapy time was 15.7 +/- 8.7 min for RF, 7.2 +/- 4.5 min for CB, and 5.7 + 2.6 min. Acute isolation of all target PVs was achieved in 99.7% (946/949) with RF, 97.4% (1048/1076) with CB, and 97.4% (1067/1096) with LB ablation. First pass isolation rate was 82.3% (775/942) for RF, 80.4% (843/1048) for CB and 94.6% (965/1020) for LB ablation. In this multicenter registry RF PVI was associated with slightly higher acute procedural success, while procedure time was shorter with CB PVI and LB PVI was associated with higher first pass PV isolation rate.