scholarly journals Clinical Applications of Laser Technology: Laser Balloon Ablation in the Management of Atrial Fibrillation

Micromachines ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 188
Author(s):  
Jamario R. Skeete ◽  
Jeanne M. Du-Fay-de-Lavallaz ◽  
David Kenigsberg ◽  
Carlos Macias ◽  
Jeffrey R. Winterfield ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Laser Energy ◽  
Clinical Applications ◽  
Ablation Techniques ◽  
Cryoballoon Ablation ◽  
Laser Technology ◽  
Balloon Ablation ◽  
Established Role ◽  
Laser Balloon Ablation ◽  
Laser Balloon

Catheter-based ablation techniques have a well-established role in atrial fibrillation (AF) management. The prevalence and impact of AF is increasing globally, thus mandating an emphasis on improving ablation techniques through innovation. One key area of ongoing evolution in this field is the use of laser energy to perform pulmonary vein isolation during AF catheter ablation. While laser use is not as widespread as other ablation techniques, such as radiofrequency ablation and cryoballoon ablation, advancements in product design and procedural protocols have demonstrated laser balloon ablation to be equally safe and effective compared to these other modalities. Additionally, strategies to improve procedural efficiency and decrease radiation exposure through low fluoroscopy protocols make this technology an increasingly promising and exciting option.

scholarly journals Real use of a novel automatic motorized laser balloon for the ablation of atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
C Martignani ◽  
M Ziacchi ◽  
G Statuto ◽  
A Spadotto ◽  
A Angeletti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control System ◽  
Pulmonary Vein ◽  
Laser Energy ◽  
Pulmonary Veins ◽  
Endoscopic Ablation ◽  
Motor Control System ◽  
Balloon Ablation ◽  
Laser Balloon Ablation ◽  
Laser Balloon

Abstract Funding Acknowledgements Type of funding sources: None. Background Electric isolation of the pulmonary veins (PVs) can successfully treat patients with atrial fibrillation (AF). Isolation of pulmonary veins can be achieved by several methods: radiofrequency, cryoballoon or laser balloon ablation (LBA). The main procedural challenge with either method is to achieve a continuous circumferential lesion at the left atrium-PVs junction, with the persistence of functional gaps. Purpose A novel endoscopic ablation system equipped with a precise motor control system (MCS) has been evaluated. The balloon is used with an endoscope to directly visualize and ablate tissue at the left atrial-PVs junction with laser energy. This system enables uninterrupted, high-speed, circumferential lesion creation under direct control of the physician. The MCS is intended to reduce procedure time and to ensure continuity of ablation lesions. The feasibility of the motorized ablation in terms of extent of applicability along each PV-left atrium junction and time of use of the manual point-by-point mode has been investigated. Methods sixteen consecutive patients (male 68.7%, age 60.9 ± 7.8 years) with paroxysmal or persistent AF who underwent LBA were enrolled in our institution. Exclusion criteria were any contraindication for the procedure including the presence of intracavitary thrombosis and contraindications to general anesthesia or deep sedation. After transseptal puncture, the balloon-based endoscopic ablation system was advanced to each PV ostium, and laser energy were projected onto the target. Results A total of 62 PVs were treated with LBA; in 3 patients there was a redundant right intermediate pulmonary vein; in 4 patients there was a right common ostium and in one a left common ostium. MCS was used for 41 PVs (66.1%): in particular, MCS was used continuously between 180° and 325° degrees (50 to 90% of PV circumference) for 22 PVs (35.5%) and between 326° and 359° degrees (91 to 99% of PV circumference) for 16 veins (25.8%).  In 3 PVs (4.8%) MCS was used for the entire circumference.  During 5.659 (23.6%) seconds out of a total of 23.986 seconds, laser energy delivery occurred in the rapid mode by MCS. No clinical complications, either local or systemic (stroke or TIA, pericardial effusion, pericardial  tamponade, pulmonary vein stenosis, esophageal injury, temporary or permanent phrenic nerve palsy), were observed neither during the use of MSC nor during the use of manual point-by-point mode. Of note, a pinhole rupture of the balloon occurred in the first 2 cases of our series, during the use of MCS, without harm to the patient and requiring only replacement of the LBA. Conclusions In our case series, laser balloon ablation with the help of motor control system appears safe and feasible in most cases for large portions of pulmonary vein circumference, providing considerable time sparing (66.1% of total ablation extent in 23.6% of total ablation time).

scholarly journals Real use of a novel automatic motorized laser balloon for the ablation of atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Martignani ◽  
M Ziacchi ◽  
G Statuto ◽  
L Bartoli ◽  
A Spadotto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control System ◽  
Pulmonary Vein ◽  
Laser Energy ◽  
Pulmonary Veins ◽  
Endoscopic Ablation ◽  
Motor Control System ◽  
Balloon Ablation ◽  
Laser Balloon Ablation ◽  
Laser Balloon

Abstract Background Electric isolation of the pulmonary veins (PVs) can successfully treat patients with atrial fibrillation (AF). Isolation of pulmonary veins can be achieved by several methods: radiofrequency, cryoballoon or laser balloon ablation (LBA). The main procedural challenge with either method is to achieve a continuous circumferential lesion at the left atrium-PVs junction, with the persistence of functional gaps. Purpose A novel endoscopic ablation system equipped with a precise motor control system (MCS) has been evaluated. The balloon is used with an endoscope to directly visualize and ablate tissue at the left atrial-PVs junction with laser energy. This system enables uninterrupted, high-speed, circumferential lesion creation under direct control of the physician. The MCS is intended to reduce procedure time and to ensure continuity of ablation lesions. The feasibility of the motorized ablation in terms of extent of applicability along each PV-left atrium junction and time of use of the manual point-by-point mode has been investigated. Methods 27 consecutive patients (male 70.3%, age 61.2±8.7 years) with paroxysmal or persistent AF who underwent LBA were enrolled in our institution. Exclusion criteria were any contraindication for the procedure including the presence of intracavitary thrombosis and contraindications to general anesthesia or deep sedation. After transseptal puncture, the balloon-based endoscopic ablation system was advanced to each PV ostium, and laser energy were projected onto the target. Results A total of 110 PVs were treated with LBA; in 9 patients there was a redundant right intermediate pulmonary vein; in 4 patients there was a right common ostium and in 2 a left common ostium. MCS was used for 82 PVs (74.5%): in particular, MCS was used continuously between 180° and 325° degrees (50 to 90% of PV circumference) for 35 PVs (31.8%) and between 326° and 359° degrees (91 to 99% of PV circumference) for 25 veins (22.7%). In 13 PVs (12%) MCS was used for the entire circumference. During 8508 (19.6%) seconds out of a total of 43.368 seconds, laser energy delivery occurred in the rapid mode by MCS. No clinical complications, either local or systemic (stroke or TIA, pericardial effusion, pericardial tamponade, pulmonary vein stenosis, esophageal injury, temporary or permanent phrenic nerve palsy), were observed neither during the use of MSC nor during the use of manual point-by-point mode. Of note, a pinhole rupture of the balloon occurred in 3 cases of our series, during the use of MCS, without harm to the patient and requiring only replacement of the LBA. Conclusions In our case series, laser balloon ablation with the help of motor control system appears safe and feasible in most cases for large portions of pulmonary vein circumference, providing considerable time sparing (74.5% of total ablation extent in 19.6% of total ablation time). FUNDunding Acknowledgement Type of funding sources: None.

Difference of myocardial injury, inflammation and early recurrence after pulmonary vein isolation among laser balloon ablation, radiofrequency catheter ablation and cryoballoon ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Yano ◽  
M Nishino ◽  
H Nakamura ◽  
Y Matsuhiro ◽  
K Yasumoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Myocardial Injury ◽  
Early Recurrence ◽  
Left Ventricular ◽  
Cryoballoon Ablation ◽  
Echocardiographic Parameters ◽  
History Of ◽  
Hs Crp ◽  
Balloon Ablation ◽  
Laser Balloon Ablation

Abstract Background Pulmonary vein isolation (PVI) has become well-established as the main therapy for patients with drug-refractory paroxysmal atrial fibrillation (PAF) and various isolation methods including radiofrequency ablation (RFA), cryoballoon ablation (CBA) and laser balloon ablation (LBA) were available. Pathological findings in each ablation methods such as myocardial injury and inflammation are thought to be different. High sensitive cardiac troponin I (hs-TnI), subunit of cardiac troponin complex, is a sensitive and specific marker of myocardium injury. High-sensitive C-reactive protein (hs-CRP) is a biomarker of inflammation and is elevated following cardiomyocyte necrosis. Relationship between myocardial injury and inflammation after ablation using RFA, CBA and LBA and early recurrence of atrial fibrillation (ERAF) remains unclear. Methods We enrolled consecutive PAF patients from Osaka Rosai Atrial Fibrillation (ORAF) registry who underwent PVI from January 2019 to October 2019. We compared the clinical characteristics including age, gender, hypertension, diabetes mellitus, history of heart failure, CHADS2Vasc score, renal function, serum BNP level and echocardiographic parameters including left ventricular dimensions, left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) between RFA, CBA and LBA groups. We investigated the difference of relationship between myocardial injury marker (hs-TnI), inflammation markers (white blood cell change (DWBC) from post to pre PVI, neutrophil-to-lymphocyte ratio change (DNLR) from after to before PVI and hs-CRP) at 36–48 hours after PVI and ERAF (<3 months after PVI) between each group. Results We enrolled 187 consecutive PAF patients who underwent PVI. RFA, CBA and LBA groups comprised 108, 57 and 22 patients, respectively. There were no significant differences of age, gender, hypertension, diabetes mellitus, history of heart failure, CHADS2Vasc score, renal function, serum BNP level and echocardiographic parameters between each group. Serum hs-TnI in RFA group and LBA group were significantly lower than in CBA group (2.643 ng/ml vs 5.240ng/ml, 1.344 ng/ml vs 5.240 ng/ml, p<0.001, p=0.002, respectively, Figure). DWBC was significantly higher in LBA group than CBA group (1157.3/μl vs 418.4/μl, p=0.045). DNLR did not differ between each group. Hs-CRP in RFA group and LBA group were significantly higher than in CBA group (1.881 mg/dl vs 1.186 mg/dl, 2.173 mg/dl vs 1.186 mg/dl, p=0.010, p=0.003, respectively, Figure). Incidence of ERAF was significantly higher in LBA group than RFA group (36.4% vs 16.7%, p=0.035). Incidence of ERAF tended to be higher in LBA group than CBA group (36.4% vs 19.3%, p=0.112). Conclusion LBA may cause less myocardial injury than RFA and CBA, on the contrary LBA may cause more inflammation than CBA. Incidence of ERAF in LBA was highest between each procedure. Inflammation markers and ERAF Funding Acknowledgement Type of funding source: None

scholarly journals Vagal Reactions During Laser Balloon Ablation in Patients with Paroxysmal Atrial Fibrillation

2021 ◽  
Author(s):  
Kaoru Okishige ◽  
Tatsuhiko Hirao ◽  
Atsushi Oda ◽  
Takatoshi Shigeta ◽  
Rena A. Nakamura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Balloon Ablation ◽  
Laser Balloon Ablation ◽  
Laser Balloon

scholarly journals First Dutch experience with the endoscopic laser balloon ablation system for the treatment of atrial fibrillation

2014 ◽  
Vol 23 (2) ◽  
pp. 96-99 ◽  
Author(s):  
P. Gal ◽  
J. J. J. Smit ◽  
A. Adiyaman ◽  
A. R. Ramdat Misier ◽  
P. P. H. M. Delnoy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Endoscopic Laser ◽  
Balloon Ablation ◽  
Dutch Experience ◽  
Laser Balloon Ablation ◽  
Laser Balloon

Electrical isolation of the superior vena cava by laser balloon ablation in patients with atrial fibrillation

2018 ◽  
Vol 53 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Martín R. Arceluz ◽  
Pedro F. Cruz ◽  
Estela Falconi ◽  
Rosa Montes de Oca ◽  
Reina Delgado ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Electrical Isolation ◽  
Balloon Ablation ◽  
Laser Balloon Ablation ◽  
Laser Balloon

scholarly journals Pulmonary Vein Stenosis After Laser Balloon Ablation for Atrial Fibrillation

2015 ◽  
Vol 1 (3) ◽  
pp. 220-221 ◽  
Author(s):  
Narendra Kumar ◽  
Laurent Pison ◽  
Yuri Blaauw ◽  
Carl Timmermans ◽  
Mark La Meir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Stenosis ◽  
Balloon Ablation ◽  
Vein Stenosis ◽  
Laser Balloon Ablation ◽  
Laser Balloon

scholarly journals Quantitative analysis of the isolation area after larger-size laser balloon ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yamasaki ◽  
T Hattori ◽  
K Kakita ◽  
K Oota ◽  
N Miyai ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Balloon Catheter ◽  
Posterior Wall ◽  
Maximum Pressure ◽  
Cryoballoon Ablation ◽  
Visually Guided ◽  
Balloon Ablation ◽  
Laser Balloon Ablation ◽  
Pulmonary Vein Antrum Isolation ◽  
Laser Balloon

Abstract Background The visually guided laser balloon ablation is a balloon-based catheter ablation technology used for atrial fibrillation (AF) ablation in recent years. This balloon catheter consists of a compliant balloon that has the capability of real-time endoscopic visualization of the targeted pulmonary vein (PV). The sizeable balloon is usually inflated to obtain optimal PV occlusion. The isolation area after laser balloon (LB) ablation was reported to be smaller than that after cryoballoon ablation. However, when LB is inflated with its maximum pressure, it can visualize wide-area PV antrum. Thereby, we suspected that larger-size LB can create wider isolation area. Purpose The aim of this study is to quantitatively evaluate the isolation area after LB ablation at the size larger than appropriate size for ablation in the pulmonary vein carina region. Methods We assessed 66 patients with AF who underwent LB ablation at the larger inflation size in our hospital during the period from July 2018 to July 2019. After LB ablation, we created voltage maps with a circular mapping catheter and calculated isolation areas with CARTO system. Results Figure shows a larger LB with its maximum pressure. PV antrum isolation was extended to the posterior wall in all patients. The left- and right-sided pulmonary vein antrum isolation area were 15.1±3.9 and 19.4±4.3 cm2, respectively. Conclusion LB at the larger inflation size with its maximum pressure can isolate wider-area circumferential PV antrum than previously reported. This method may be a new way of pulmonary vein antrum isolation. Left atrial voltage mapping after PVI. Funding Acknowledgement Type of funding source: None

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