Comparison between minimal fluoroscopy and conventional approaches for visually guided laser balloon pulmonary vein isolation ablation.

Abstract

Although balloon-based techniques, such as the laser balloon (LB) ablation have simplified pulmonary vein isolation (PVI), procedural fluoroscopy usage remains higher in comparison to radiofrequency PVI approaches due to limited 3-dimensional mapping system integration. In this prospective study, 50 consecutive patients were randomly assigned in alternating fashion to a low fluoroscopy group (LFG;n = 25) or conventional fluoroscopy group (CFG;n = 25) and underwent de novo PVI procedures using visually guided LB technique. There was no statistical difference in baseline characteristics or cross-overs between treatment groups. Acute PVI was accomplished in all patients. Mean follow up was 318 ± 69 days. Clinical recurrence of atrial fibrillation after PVI was similar between groups (CFG: 19% vs LFG: 15%; P = .72). Total fluoroscopy time was significantly lower in the LFG than the CFG (1.7 ± 1.4 vs16.9 ± 5.9 minutes; P < .001) despite similar total procedure duration (143 ± 22vs148 ± 22 minutes; P = .42) and mean LA dwell time (63 ± 15vs59 ± 10 minutes; P = .28). Mean dose area product was significantly lower in the LFG (181 ± 125vs1980 ± 750 μGym2 ; P < .001). Fluoroscopy usage after transseptal access was substantially lower in the LFG (0.63 ± 0.43vs11.70 ± 4.32 minutes; P < .001). Complications rates were similar between both groups (4% vs2%; P = .57). This study demonstrates that LB PVI can be safely achieved using a novel low fluoroscopy protocol while also substantially reducing fluoroscopy usage and radiation exposure in comparison to conventional approaches for LB ablation.