Feasibility of circumferential pulmonary vein isolation using a novel endoscopic ablation system.
BACKGROUND
Pulmonary vein isolation (PVI) is an established treatment option for patients with drug refractory paroxysmal atrial fibrillation. A novel compliant endoscopic ablation system housing a 980-nm-diode laser allows for discrete point-by-point ablation enabling a true circumferential ablation line design. We sought to determine the feasibility and safety of a circumferential ablation using endoscopic ablation system.


RESULTS
Thirty patients (17 female; mean age, 58±9 years) with a median paroxysmal atrial fibrillation history of 3 years (range, 1 to 17 years) were treated. PVI was achieved in 114 of 116 (98%) PVs (4 left common PVs), thereby achieving simultaneous PVI for separate ipsilateral PVs in 19 of 26 (73%) left PVs and 6 of 30 (20%) right PVs. The total procedure time was 250±62 minutes. Procedure time decreased from 310±59 to 220±37 minutes (P=0.0001) between the first 10 and the last 20 cases. Mean fluoroscopy time was 30±18 minutes. Twenty-seven patients underwent postoperative endoscopy showing no or minimal thermal lesions in the esophagus in 21 (78%) and 2 (7%), respectively. In 4 (15%) patients, an esophageal ulceration was found that healed without sequelae. One pericardial tamponade and 1 right-sided phrenic nerve palsy occurred. During a median follow-up of 168 days (113 to 203 days; q1-q3), 24 of 30 patients (80%) remained free of atrial fibrillation recurrence.


CONCLUSIONS
Circumferential PVI using the novel compliant endoscopic ablation system was feasible in the majority of left PVs and minority of right PVs accompanied by a complication rate comparable to established approaches. To minimize the risk for thermal esophageal injury temperature monitoring is recommended.
Schmidt
Boris
B
Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany. boris_schmidt@arcor.de
Metzner
Andreas
A
Chun
Kyoung Ryul Julian
KR
Leftheriotis
Dionysios
D
Yoshiga
Yasuhiro
Y
Fuernkranz
Alexander
A
Neven
Kars
K
Tilz
Roland Richard
RR
Wissner
Erik
E
Ouyang
Feifan
F
Kuck
Karl-Heinz
KH
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D004452:Echocardiography; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome