title: Visually guided pulmonary vein isolation in patients with persistent atrial fibrillation.
abstract: OBJECTIVE
  The role of balloon catheters in patients with persistent forms of atrial fibrillation (AF) remains ill defined. We therefore sought to assess the safety and efficacy of a laser balloon (LB)-guided pulmonary vein isolation (PVI) in consecutive all-comers with persistent AF.
  
  
  RESULTS
  All patients undergoing an LB-guided PVI procedure for persistent AF between January 2011 and December 2012 were matched to patients undergoing circumferential PVI using irrigated radiofrequency (RF) current ablation for date of procedure, age, gender, AF duration, left atrial (LA) size, and left ventricular ejection fraction. The primary endpoint was freedom from AF between 90 and 365 days post-ablation after a single procedure. Eighty patients (mean age 66 ± 9; 71% male) with a median (Q1-Q3) AF episode duration of 2 (1-3) months underwent successful PVI in the two groups. The primary endpoint of 1-year single procedure AF/atrial tachycardia (AT) recurrences was reached by 11/40 (27.5%) patients in the LB group and in 9/40 (22.5%) patients in the RF group (P = 0.87). During a mean follow-up of 517 ± 170 days, 13 (32.5%) and 16 (40%) patients in the LB and RF groups, respectively, experienced AF/AT recurrences (P = 0.64). Procedural complications occurred in one patient in the LB group and in six patients in the RF group.
  
  
  CONCLUSIONS
  A subset of patients with drug-refractory persistent AF of short duration benefit from pure PVI without additional substrate modification. A LB-based strategy showed similar outcomes as an irrigated RF-guided circumferential PVI and may be considered an alternative option for the index ablation.
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: Stefano
authors: S
authors: Bordignon
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: Marie-Christine
authors: MC
authors: Boehmer
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: Annemarie
authors: A
authors: Klostermann
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: Alexander
authors: A
authors: Fuernkranz
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: Laura
authors: L
authors: Perrotta
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: Daniela
authors: D
authors: Dugo
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany.
authors: K R Julian
authors: KR
authors: Chun
authors: Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Str. 4, Frankfurt/M 60431, Germany b.schmidt@ccb.de.
authors: Boris
authors: B
authors: Schmidt
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018572:Disease-Free Survival; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Balloon catheter ablation; Catheter ablation; Endoscopic ablation system; Persistent atrial fibrillation