Feasibility and safety of left atrial roof ablation with the third-generation visually guided laser balloon

Abstract

Abstract Background The roof area ablation beyond pulmonary vein (PV) isolation (PVI) using a cryoballoon has been widely performed for patients with atrial fibrillation (AF). However, the feasibility of roof area ablation using a visually guided laser balloon (VGLB) remains to be elucidated. Purpose This study aims to investigate the feasibility and safety of additional roofline creation by VGLB ablation alone in patients with AF. Methods A total of 30 patients with AF (paroxysmal AF=15, persistent AF=15) who underwent VGLB ablation from March 2023 to August 2023 were analyzed retrospectively. VGLB ablation was performed using a third-generation VGLB. After initial circular ablation, VGLB was inflated to a larger size to extend and fuse the isolation area at the roof portion during the superior PVs occlusion. The complete conduction block of the left atrial (LA) roof was assessed by the differential pacing methods and the high-resolution mapping system at the end of the procedure. Results Acute success in complete roofline creation was achieved in 70% of patients. The PVI time was 21.6±5.5 minutes, and additional roof ablation time was 8.7±3.5 minutes, respectively. The anatomical LA roof length was significantly shorter in patients with successful roofline generation than without (30.4±7.2mm vs. 42.9±4.0mm, P<0.001). A cut-off value of 40.2mm for the LA roof length calculated by a receiver operating characteristic curve predicted a successful construction of the LA roofline with the highest sensitivity of 94.7%, specificity of 83.3%, and the area under the curve was 0.94 (95% confidence interval, 0.35-0.99). No complications occurred during laser energy titration at the roof area. Conclusion The roofline creation using a third-generation VGLB is possible with acceptable safety concerns. The length of the LA roof≤40.2mm was a predictor of the successful LA roofline generation.Fluoroscopic and endoscopic imageVoltage map after ablation