Single-Sweep Pulmonary Vein Isolation using the new third-generation
laser balloon -- Evolution in ablation style using endoscopic ablation
system
Abstract
Background: The endoscopic ablation system (EAS) is an established
ablation device for pulmonary vein isolation (PVI) in patients with
atrial fibrillation (AF). The novel X3 EAS is now equipped with a
contiguous circumferential ablation mode (RAPID mode). Aim: To determine
the feasibility of single-sweep ablation using X3. Methods: Consecutive
patients who underwent AF ablation using X3 were enrolled. We assessed
the acute procedural data focusing on “Single-sweep PVI” defined as
PVI with a single energy application using RAPID mode to complete the
circular lesion set, and on “first-pass isolation” defined as
successful visually guided PVI after initial circular lesion set.
Results: One-hundred AF patients (56% male, age 68±10 years, 66%
paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were
isolated with X3. Single-sweep isolation and first-pass-isolation were
achieved in 214 PVs (56%) and in 362 PVs (95%), respectively.
Single-sweep isolation rates varied across PVs with higher rates at the
superior PVs (61.2% vs. inferior PVs:49.5%, P=0.0239) and at PVs with
maximal ostial diameter <24mm (57.6% vs. >24mm:
36.8%, P=0.0151). The mean total procedure and fluoroscopy times were
43.0±10 and 4.0±2 mins, respectively. In none of the patients an acute
thromboembolic event (stroke or transient ischemic attack) or a
pericardial effusion/tamponade occurred. A single transient phrenic
nerve palsy was observed. Conclusion: The new X3 EAS allows for
single-sweep PVI in 56% of PVs. The new RAPID ablation mode leads to an
improved rate of first-pass isolation associated with very short
procedure times without compromising safety.