Background: Pulmonary Vein ablation (PVI) is the cornerstone of an atrial fibrillation (AF) ablation procedure. However, PV reconnection and clinical relapses of AF following the first AF ablation is frequent and a challenge to the field. Laser ballon endoscopic guided ablation (LABEGA) offers an anatomy- guided gapless ablation option with the potential of a high permanent PV disconnection rate and thus a favourable clinical outcome.
Methods: In a prospective ablation registry, 3 centers included 178 pts. (39.3% pers. AF, 60.7% paroxysmal AF, mean CHA2DS2-VASC 2.1±1.5) who underwent LABEGA; data was collected at baseline, intra- and postprocedural and at 1 year post ablation.
Results: Procedures were conducted under general anesthesia in 31.4% and under conscious sedation in 68% of pts. Mean x-ray duration was 16.1±10.4 min with a left atrial time of 110.1±31.1 min and a total procedure time of 131.4±38.5 min. In 90.4% of pts. all 4 PV′s could be isolated, while 57.1% used 3D Mapping in addition to the LABEGA approach. Major in-hospital complications occurred in 9 pts. or 5% (1 stroke, 2 pericardial tamponade, 1 severe bleeding, 5 with persistent phrenic nerve paresis at discharge). Recurrent symptomatic AF could be observed in 42 pts. (23.6%) which leads to a clinical success rate of 74.4% with the first procedure. 19 pts. (12.8%) underwent a repeat ablation procedure.
Conclusion: LABEGA offers an effective PV disconnection strategy with a high, single procedure success rate. Major complication rate is within the reported range. A prospective head to head comparison to other balloon technologies is needed to potentially demonstrate superior efficacy.