PMC:6019327 / 237094-239190
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6019327","sourcedb":"PMC","sourceid":"6019327","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6019327","text":"A laser balloon ablation system transmits light energy through a balloon filled with deuterium oxide (D2O, or “heavy water”) to perform PVI.498,508,699,700,701 The unique part of this system is that the lumen of the catheter contains a fiber optic endoscope that allows PVI under direct visualization. The balloon is compliant, allowing a variable inflation diameter from 25–32 mm, depending on PV size, and is delivered via a 16 Fr outer-diameter steerable sheath. Once the balloon is inflated, the diode laser emits energy in a 30-degree arc of overlapping lesions that can be rotated around the circumference of the PV and tracked visually using special software. The power of the laser ablation energy can be titrated from 5.5 to 12 W, lasting for 20–30 seconds for each ablation lesion. Lower power is used when blood is present in the field of view or when the laser is overlying the posterior LA wall, and higher power is favored over remaining PV segments in order to achieve persistent PVI.502 The endoscope has a 115-degree field of view (partially blocked by the lesion generator), and the balloon catheter is then rotated to complete the isolation. Each PV is typically individually isolated, as opposed to the individual or pairwise isolation used during point-by-point RF ablation. A multicenter, prospective pivotal trial of the laser balloon for treating PAF found that freedom from AF after a single laser balloon ablation was noninferior, and nearly identical, to the success rate using irrigated RF ablation (61.1% laser vs 61.7% RF; P = .003 for noninferiority), with a similar safety profile.503 PN injury was more common using the laser balloon (3.5% vs 0.6%; P =.05), but PV stenosis was less common (0.0% vs 2.9%; P =.03). In a single-center randomized study, AF recurrence after ablation was similar using the laser balloon compared with the first-generation CB (27% vs 37%; P = .18).501,502 The laser balloon has been used commercially in Europe and has received FDA approval for use in the United States to treat patients with drug refractory recurrent symptomatic 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