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Is creation of a fully circumferential lesion set necessary for laser balloon ablation-based pulmonary vein isolation?

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Despite reports of remote pulmonary vein (PV) stenosis after visually guided laser balloon (VGLB) ablation, circumferential (360°) lesion sets are routinely performed. This study aimed to determine whether fully circumferential lesion creations are required for all PVs to achieve PV isolations (PVIs) and to determine PV’s vulnerability to chronic-phase stenosis.

Methods

Fifty-one patients with paroxysmal atrial fibrillation underwent mapping-guided PVIs using circular mapping catheters. VGLB ablation was performed circumferentially beginning at the 12 o’clock position and continued clockwise or counterclockwise. PVIs obtained within the bounds of the first half of the circumferential lesion (≤ 180°) were defined as “early PVIs.”

Results

“Early PVIs” were documented in real time for 39% (80/204) of the PVs and at a significantly greater frequency among lower PVs than upper PVs (60.1% vs. 17.6%; p < 0.0001). The PV sleeve length, PV diameter, and isolation of ipsilateral PVs within a semicircular lesion set were identified as predictors of an “early PVI” phenomenon. The amount of energy delivered to the lower PVs was significantly less than that to the upper PVs (5553 [5089–6188] vs. 3559 [2793–4380] J; p < 0.0001), but the incidence of narrowing of the lower PVs at 6 months was comparable to that of the upper PVs (p = 0.73).

Conclusion

Our study revealed electrical isolations of more than 60% of the lower PVs while creating the first half of the circumferential lesions. Crosstalk via the carina region was presumably involved due to the preceding upper PVI. Further study is needed to determine whether energy delivery adjustments are needed for lower PVs to avoid chronic narrowing.

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Authors and Affiliations

  1. Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan

    Hirotsugu Sato, Shiro Nakahara, Reiko Fukuda, Yuichi Hori, Hideyuki Aoki, Yuki Kondo, Masatoshi Shimura, Yuri Koshikawa, Yukiko Mizutani, Itaru Hisauchi, Yuji Itabashi, Sayuki Kobayashi, Tetsuya Ishikawa & Isao Taguchi

Authors
  1. Hirotsugu Sato
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  2. Shiro Nakahara
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  3. Reiko Fukuda
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  4. Yuichi Hori
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  5. Hideyuki Aoki
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  14. Isao Taguchi
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Contributions

All authors contributed to the manuscript. The first draft of the manuscript was written by Hirotsugu Sato and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shiro Nakahara.

Ethics declarations

Ethics approval

The Bioethics Committee of Dokkyo Medical University Saitama Medical Center approved the study protocol (acceptance number: 21048).

Consent to participate

Informed consent was obtained from the patient before the procedure.

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Patients signed informed consent regarding publishing their data and photographs.

Conflict of interest

Dr. Nakahara received speaker honoraria from Japan Lifeline Co. Other authors have no financial or proprietary interests in any material discussed in this article.

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Sato, H., Nakahara, S., Fukuda, R. et al. Is creation of a fully circumferential lesion set necessary for laser balloon ablation-based pulmonary vein isolation?. J Interv Card Electrophysiol 66, 701–710 (2023). https://doi.org/10.1007/s10840-022-01396-6

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  • DOI: https://doi.org/10.1007/s10840-022-01396-6

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