title: The durability of pulmonary vein isolation using the visually guided laser balloon catheter: multicenter results of pulmonary vein remapping studies.
abstract: BACKGROUND
  The visually guided laser ablation (VGLA) catheter is a compliant, variable-diameter balloon that delivers laser energy around the pulmonary vein (PV) ostium under real-time endoscopic visualization. While acute PV isolation has been shown to be feasible, limited data exist regarding the durability of isolation.
  
  
  OBJECTIVE
  We sought to determine the durability of PV isolation following ablation using the balloon-based VGLA catheter.
  
  
  METHODS
  The VGLA catheter was evaluated in patients with paroxysmal atrial fibrillation (3 sites, 10 operators). Following transseptal puncture, the VGLA catheter was advanced through a 12-F deflectable sheath and inflated at the target PV ostium. Under endoscopic guidance, the 30° aiming arc was maneuvered around the PV and laser energy was delivered to ablate tissue in a contiguous/overlapping manner. At ∼3 months, all patients returned for a PV remapping procedure.
  
  
  RESULTS
  In 56 patients, 202 of 206 PVs (98%) were acutely isolated. At 105 ± 44 (mean ± SD) days, 52 patients returned for PV remapping at which time 162 of 189 PVs (86%) remained isolated and 32 of 52 patients (62%) had all PVs still isolated. On comparing the operators performing <10 vs ≥ 10 procedures, the durable PV isolation rate and the percentage of patients with all PVs isolated were found to be 73% vs 89% (P = .011) and 57% vs 66% (P = .746), respectively. After 2 procedures and 12.0 ± 1.9 months of follow-up, the drug-free rate of freedom from atrial fibrillation was 71.2%.
  
  
  CONCLUSIONS
  In this multicenter, multioperator experience, VGLA resulted in a very high rate of durable PV isolation with a clinical efficacy similar to that of radiofrequency ablation.
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.forename: Petr
authors.initials: P
authors.lastname: Neuzil
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.forename: Jan
authors.initials: J
authors.lastname: Petru
authors.forename: Dan
authors.initials: D
authors.lastname: Wichterle
authors.forename: Jan
authors.initials: J
authors.lastname: Skoda
authors.forename: Robert
authors.initials: R
authors.lastname: Cihak
authors.forename: Petr
authors.initials: P
authors.lastname: Peichl
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D017546:Angioscopy / Q000379:methods*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D002404:Catheterization / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult