Urbanek Lukas, Bordignon Stefano, Tohoku Shota, Hirokami Jun, Nagase Takahiko, Chen Shaojie, Schaack David, Chun K R Julian, Schmidt Boris
Cardioangiologisches Centrum Bethanien Agaplesion Markus-Krankenhaus Frankfurt/M Germany.
Department of Cardiology Sakakibara Heart Institute Fuchushi Tokyo Japan.
J Arrhythm. 2024 Jun 14;40(4):839-848. doi: 10.1002/joa3.13088. eCollection 2024 Aug.
Laser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long-term follow-up and procedural data of LB-PVI and we compare the first and second LB generation.
Patients undergoing LB ablation with first- (LB1) or second-generation LB (LB2) for AF were retrospectively enrolled and divided into two groups. Procedural endpoint was complete PVI. Clinical success was defined as no recurrence of AF/atrial tachycardia after a 90 days blanking period.
538 patients were included (age 66 ± 10 years, 58% paroxysmal AF), 427 in LB1 and 111 in LB2. 2079 PVs were targeted and 2073 (99.7%) were successfully isolated; 2027 (97.5%) using solely the LB. Additional touch-up ablation was limited (46 PVs; 2.2%) with no difference between the groups. Procedural (LB1: 120 ± 33 minutes vs. LB2: 99 ± 22 min; < .001) and fluoroscopy time (LB1: 11.2 ± 5 min vs. LB2: 8.5 ± 3 min; < .001) were shorter with LB2. The complication rate was 8.9% (LB1: 10.1% vs. LB2: 4.5%; = .067) with most complications resulting from the access site (21/48). Overall freedom from AF after 1-year was 73.7% (paroxysmal AF: 76.9%; persistent AF: 69.3%; < .001) with no difference between the groups (LB1: 73.4% vs. LB2: 74.7%; = .491).
LB showed a high efficacy and acceptable safety, with numerically lower complication rates with the second-generation LB. Procedure and fluoroscopy times were shorter with LB2. Overall, 73.7% of patients were free from AF at 1-year, with comparable results among both generations.
激光球囊（LB）肺静脉隔离术（PVI）是一种成熟的房颤（AF）消融技术。我们报告了LB-PVI的长期随访和手术数据，并比较了第一代和第二代LB。
回顾性纳入接受第一代（LB1）或第二代LB（LB2）房颤消融术的患者，并分为两组。手术终点为完全PVI。临床成功定义为在90天空白期后房颤/房性心动过速无复发。
共纳入538例患者（年龄66±10岁，58%为阵发性房颤），其中LB1组427例，LB2组111例。共靶向2079条肺静脉，2073条（99.7%）成功隔离；仅使用LB成功隔离2027条（97.5%）。额外的补充消融有限（46条肺静脉；2.2%），两组之间无差异。LB2组的手术时间（LB1：120±33分钟 vs. LB2：99±22分钟；<0.001）和透视时间（LB1：11.2±5分钟 vs. LB2：8.5±3分钟；<0.001）更短。并发症发生率为8.9%（LB1：10.1% vs. LB2：4.5%；P = 0.067），大多数并发症源于穿刺部位（21/48）。1年后房颤总体缓解率为73.7%（阵发性房颤：76.9%；持续性房颤：69.3%；<0.001），两组之间无差异（LB1：73.4% vs. LB2：74.7%；P = 0.491）。
LB显示出高疗效和可接受的安全性，第二代LB的并发症发生率在数值上更低。LB2组的手术和透视时间更短。总体而言，73.7%的患者在1年后无房颤，两代之间结果相当。
