Five-year clinical outcomes of visually guided laser balloon pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation

Background: Visually guided laser balloon (VGLB) ablation allows for pulmonary vein isolation (PVI) under direct endoscopic control. Short- and midterm clinical outcomes are in accordance with results of radiofrequency current (RFC) ablation for the treatment of paroxysmal atrial fibrillation (PAF). Objective: The current study sought to assess the long-term clinical outcomes of VGLB-based PVI for PAF. Methods: A total of 90 patients [60 ± 10 years; 33 (37%) female, left atrial diameter 42 ± 4 mm] with drug-refractory PAF underwent VGLB ablation. The median duration of PAF until VGLB ablation was 36 (interquartile range 12; 84) months. Follow-up was based on outpatient clinic visits including Holter ECGs and telephone interviews. Repeat ablation due to arrhythmia recurrences was performed using RFC ablation. Results: After a single VGLB procedure, 5-year freedom from arrhythmia recurrence was 51% [95% confidence interval (CI) 39–62%]. Thirty-three patients underwent repeat RFC ablation procedures, resulting in multiple procedure freedom from arrhythmia recurrence of 78% (95% CI 68–88%). Major periprocedural complications occurred in four patients (4%). Conclusions: VGLB ablation for the treatment of drug-refractory PAF is safe and results in 5-year single and multiple procedure arrhythmia-free survival of 51 and 78%, respectively.