Laserablation von Vorhofflimmern

Abstract

Catheter ablation of drug-refractory atrial fibrillation is a challenging procedure even for skillful operators. Non-transmural ablation lesions due to suboptimal catheter to tissue contact result in electrical reconnection of previously isolated pulmonary veins (PVs) and subsequently are the dominant reason for clinical AF recurrences. The novel laser ballon catheter enables precise visually controlled ablation by an integrated 2 F endoscope at maximal tissue contact. Initial clinical results are promising demonstrating high chronic PV isolation rates and remarkable single procedure success rates. Future randomized trials will have to determine ist role in the interventional cardiologist’s arena.

• Literatur

• 1 Camm AJ, Lip GY, De Caterina R et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation – developed with the special contribution of the European Heart Rhythm Association. Europace 2012; 14: 1385-1413
• 2 Jais P, Cauchemez B, Macle L et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 2008; 118: 2498-2505
• 3 Calkins H, Reynolds MR, Spector P et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circulation: Arrhythmia and Electrophysiology 2009; 2: 349-361
• 4 Weerasooriya R, Khairy P, Litalien J et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up?. J Am Coll Cardiol 2011; 57: 160-166
• 5 Ouyang F, Tilz R, Chun J et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 2010; 122: 2368-2377
• 6 Ouyang F, Antz M, Ernst S et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation 2005; 111: 127-135
• 7 Cappato R, Negroni S, Pecora D et al. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation 2003; 108: 1599-1604
• 8 Petersen HH, Chen X, Pietersen A et al. Tissue temperatures and lesion size during irrigated tip catheter radiofrequency ablation: an in vitro comparison of temperature-controlled irrigated tip ablation, power-controlled irrigated tip ablation, and standard temperature-controlled ablation. Pacing Clin Electrophysiol 2000; 23: 8-17
• 9 Wittkampf FH, Hauer RN, Robles de Medina EO. Control of radiofrequency lesion size by power regulation. Circulation 1989; 80: 962-968
• 10 Wittkampf FH, Nakagawa H. RF catheter ablation: Lessons on lesions. Pacing Clin. Electrophysiol 2006; 29: 1285-1297
• 11 Schmidt B, Chun KR, Metzner A et al. Balloon catheters for pulmonary vein isolation. Herz 2008; 33: 580-584
• 12 Bordignon S, Chun KR, Gunawardene M et al. Endoscopic ablation systems. Expert Rev Med Devices 2013; 10: 177-183
• 13 Reddy VY, Houghtaling C, Fallon J et al. Use of a diode laser balloon ablation catheter to generate circumferential pulmonary venous lesions in an open-thoracotomy caprine model. Pacing Clin Electrophysiol 2004; 27: 52-57
• 14 Lemery R, Veinot JP, Tang AS et al. Fiberoptic balloon catheter ablation of pulmonary vein ostia in pigs using photonic energy delivery with Diode laser. Pacing Clin Electrophysiol 2002; 25: 32-36
• 15 Reddy VY, Neuzil P, Themistoclakis S et al. Visually-guided balloon catheter ablation of atrial fibrillation: experimental feasibility and first-in-human multicenter clinical outcome. Circulation 2009; 120: 12-20
• 16 Dukkipati SR, Neuzil P, Skoda J et al. Visual balloon-guided point-by-point ablation: reliable, reproducible, and persistent pulmonary vein isolation. Circ Arrhythm Electrophysiol 2010; 3: 266-273
• 17 Schmidt B, Gunawardene M, Urban V et al. Visually guided sequential pulmonary vein isolation: insights into techniques and predictors of acute success. J Cardiovasc Electrophysiol 2012; 23: 576-582
• 18 Chun KR, Schulte-Hahn B, Gunawardene M et al. Witnessed pulmonary vein arrest-endoscopically observed conversion of atrial fibrillation into sinus rhythm by laser balloon ablation. Herz 2012; 37: 336-337
• 19 Bordignon S, Chun KR, Gunawardene M et al. Energy titration strategies with the endoscopic ablation system: lessons from the high-dose vs. low-dose laser ablation study. Europace 2012; DOI: 10.1093/europace/eus352.
• 20 Metzner A, Wissner E, Schoonderwoerd B et al. The influence of varying energy settings on efficacy and safety of endoscopic pulmonary vein isolation. Heart Rhythm 2012; 9: 1380-1385
• 21 Dukkipati SR, Neuzil P, Kautzner J et al. The durability of pulmonary vein isolation using the visually guided laser balloon catheter: multicenter results of pulmonary vein remapping studies. Heart Rhythm 2012; 9: 919-925
• 22 Schmidt B, Chun KR. Pulmonary vein remapping: adequate shortcut or cut too short?. Heart Rhythm 2012; 9: 926-927
• 23 Schmidt B, Metzner A, Chun KR et al. Feasibility of circumferential pulmonary vein isolation using a novel endoscopic ablation system. Circ Arrhythm Electrophysiol 2010; 3: 481-488
• 24 Metzner A, Kivelitz D, Schmidt B et al. Impact of pulmonary vein anatomy assessed by cardiac magnetic resonance imaging on endoscopic pulmonary vein isolation in consecutive patients. Europace 2012; 14: 474-480
• 25 Metzner A, Schmidt B, Fuernkranz A et al. Esophageal temperature change and esophageal thermal lesions after pulmonary vein isolation using the novel endoscopic ablation system. Heart Rhythm 2011; 8: 815-820
• 26 Dukkipati SR, Kuck KH, Neuzil P et al. Pulmonary Vein Isolation Using a Visually-Guided Laser Balloon Catheter: The First 200-Patient Multicenter Clinical Experience. Circ Arrhythm Electrophysiol 2013; DOI: 10.1161/CIRCEP.113.000431.
• 27 Schmidt B, Gunawardene M, Krieg D et al. A Prospective Randomized Single-Center Study on the Risk of Asymptomatic Cerebral Lesions Comparing Irrigated Radiofrequency Current Ablation with the Cryoballoon and the Laser Balloon. J Cardiovasc Electrophysiol 2013; DOI: 10.1111/jce.12151.
• 28 Bordignon S, Chun K, Gunawardene M et al. Laser or cryo? Prospective comparison of balloon based PVI strategies. Munich: European Society of Cardiology; 2012: 1-18