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Original Article

Pulmonary Vein Isolation Using a Visually Guided Laser Balloon CatheterClinical Perspective

The First 200-Patient Multicenter Clinical Experience

Srinivas R. Dukkipati, Karl-Heinz Kuck, Petr Neuzil, Ian Woollett, Josef Kautzner, H. Thomas McElderry, Boris Schmidt, Edward P. Gerstenfeld, Shephal K. Doshi, Rodney Horton, Andreas Metzner, Andre d’Avila, Jeremy N. Ruskin, Andrea Natale, Vivek Y. Reddy
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https://doi.org/10.1161/CIRCEP.113.000431
Circulation: Arrhythmia and Electrophysiology. 2013;6:467-472
Originally published June 18, 2013
Srinivas R. Dukkipati
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Karl-Heinz Kuck
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Petr Neuzil
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Ian Woollett
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Josef Kautzner
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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H. Thomas McElderry
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Boris Schmidt
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Edward P. Gerstenfeld
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Shephal K. Doshi
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Rodney Horton
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Andreas Metzner
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Andre d’Avila
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Jeremy N. Ruskin
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Andrea Natale
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Vivek Y. Reddy
From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School of Medicine, San Francisco, CA (E.P.G.); Pacific Heart Institute, Santa Monica, CA (S.K.D.); Texas Cardiac Arrhythmia Institute, Austin, TX (R.H., A.N.); and Massachusetts General Hospital, Boston, MA (J.N.R.).
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Abstract

Background—Because of the technical difficulty with achieving pulmonary vein (PV) isolation in the treatment of patients with paroxysmal atrial fibrillation, novel catheter designs to facilitate the procedure are in development. A visually guided laser ablation (VGLA) catheter was designed to allow the operator to directly visualize target tissue for ablation and then deliver laser energy to perform point-to-point circumferential ablation. Single-center studies have demonstrated favorable safety and efficacy. We sought to determine the multicenter feasibility, efficacy, and safety of performing PV isolation using the VGLA catheter.

Methods and Results—This study includes the first 200 paroxysmal atrial fibrillation patients treated with the VGLA catheter (33 operators, 15 centers). After transseptal puncture, the VGLA catheter was used to perform PV isolation. Electric isolation was assessed using a circular mapping catheter. Using the VGLA catheter, 98.8% (95% confidence interval, 97.8%–99.5%) of targeted PVs were isolated using a mean of 1.07 catheters per patient. Fluoroscopy and procedure times were 31±21 (mean±SD) and 200±54 minutes, respectively, and improved with operator experience. There were no instances of stroke, transient ischemic attack, atrioesophageal fistulas, or significant PV stenosis. There was a 2% incidence of cardiac tamponade and a 2.5% incidence of phrenic nerve palsy. At 12 months, the drug-free rate of freedom from atrial arrhythmias after 1 or 2 procedures was 60.2% (95% confidence interval, 52.7%–67.4%).

Conclusions—In this multicenter experience of the first 200 patients treated with the VGLA catheter, PV isolation can be achieved in virtually all patients using a single VGLA catheter with an efficacy similar to radiofrequency ablation.

  • atrial fibrillation
  • catheter ablation
  • lasers
  • pulmonary vein isolation
  • visual guidance
  • Received September 6, 2012.
  • Accepted March 15, 2013.
  • © 2013 American Heart Association, Inc.
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    Pulmonary Vein Isolation Using a Visually Guided Laser Balloon CatheterClinical Perspective
    Srinivas R. Dukkipati, Karl-Heinz Kuck, Petr Neuzil, Ian Woollett, Josef Kautzner, H. Thomas McElderry, Boris Schmidt, Edward P. Gerstenfeld, Shephal K. Doshi, Rodney Horton, Andreas Metzner, Andre d’Avila, Jeremy N. Ruskin, Andrea Natale and Vivek Y. Reddy
    Circulation: Arrhythmia and Electrophysiology. 2013;6:467-472, originally published June 18, 2013
    https://doi.org/10.1161/CIRCEP.113.000431

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    Pulmonary Vein Isolation Using a Visually Guided Laser Balloon CatheterClinical Perspective
    Srinivas R. Dukkipati, Karl-Heinz Kuck, Petr Neuzil, Ian Woollett, Josef Kautzner, H. Thomas McElderry, Boris Schmidt, Edward P. Gerstenfeld, Shephal K. Doshi, Rodney Horton, Andreas Metzner, Andre d’Avila, Jeremy N. Ruskin, Andrea Natale and Vivek Y. Reddy
    Circulation: Arrhythmia and Electrophysiology. 2013;6:467-472, originally published June 18, 2013
    https://doi.org/10.1161/CIRCEP.113.000431
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