Conclusion:
The VGLA guided PVI was a useful therapeutic tool even in patients with an LCPV. The presence of an LCPV was not associated with any atrial tachyarrhythmia recurrence.
Keywords
Left common pulmonary vein, catheter ablation, pulmonary vein isolation, laser balloon, atrial fibrillation
Introduction
Pulmonary vein isolation (PVI) is an effective treatment of atrial fibrillation (AF). A balloon-based visually guided laser ablation (VGLA) is considered to be a useful therapeutic tool for achieving a PVI1). A prior multicenter study revealed that VGLA was non-inferior to radiofrequency ablation in terms of the efficacy and safety in curing paroxysmal and persistent AF2,3). Moreover, a recent prospective randomized study showed that VGLA was as effective and safe as a cryoballoon (CB) guided PVI4).
The shape of the pulmonary veins (PVs) and left atrium varies among the candidates for AF ablation, and a left common pulmonary vein (LCPV) is the most frequently observed anatomical abnormality that operators encounter in performing PVI. Although radiofrequency energy (RF) ablation can be applied in a point-by-point fashion at the LCPV ostium without any difficulty, the balloon may not be able to occlude the PVs, which is mandatory for a successful PVI. The results of a balloon-based PVI may not be satisfactory especially in patients with a relatively large LCPV, and we previously reported that a CB guided PVI was unsuccessful in 15% of patients with an LCPV5). However, the clinical safety and efficacy of a VGLA has never been fully investigated in patients with an LCPV. We investigated the procedural safety and efficacy of VGLA in the patients with an LCPV.