Graphical abstract: High Density (HD) lasermapping guided AF ablation: gradual abatement of local atrial potential amplitudes (AA1) with abolishment in 4s.
This 7th laser impact aimed at the posterior left atrial wall achieved recurrence to sinus rhythm (SR) A2A3 in the 8th second.
Background After successful HD-lasermapping guided ablation of various cardiac tachyarrhythmias AF ablation was attempted in 48 patients (50-81, 69±7.6 years, female 28) with drug resistant (3.5 trials) l-lpAF (≥12 months), and with various comorbidities. All were in AF at the beginning of the procedure.
Methods First, side selective interatrial septal laser puncture was performed by using the optical fiber set ISPunctureLas®. The puncture set was then replaced by the open-irrigated laser catheter RytmoLas® and 1064nm laser applications at 15W/10-15s (14-26; 19 ± 4 per patient) were first aimed at endocardial areas of the left atrial (LA) posterior wall with the largest, most regular electrical potentials. HD Laser- mapping guided ablation was performed systematically under normothermic conditions while avoiding interfering with the electrophysiologic monitoring principles, without electrical hum during laser application. When the entire posterior LA wall was devoid of electrical activity additional lines of ablation were done if needed. The catheter was then withdrawn, and laser impacts were aimed at the right atrial postero-sepal area and if needed at the roof, the basis of atrial appendage, the sinus nodal regions, etc. until stable sinus rhythm was achieved. Abolishment of electrical potentials in the HD-Lasermapping was achieved in 4-11s (8 ± 1.5s). No other mapping procedure was used. Total procedure duration was 82-175min (118 ± 72min). X-ray exposure times ranged from 15-82min (23 ± 12min). Regular follow-up was performed by 24h Holter monitor following the procedure and by clinical checkup and ECG at rest after 3 weeks, three months, 6 months, and one year intervals in the outpatient clinic or by the house doctor, or a cardiologist. Total follow-up was 9 months to 29.3 years (8.2 ± 6.5 years).
Results The unique HD-Lasermapping visualized immediate real-time laser effects on the monitor. Laser treatment that was without complications, all the patients were in sinus rhythm and off medication. However, after 3 to 4 months 15 patients (31%) needed repeat studies for various arrhythmias including AF in two patients. After redo procedures all were in sinus rhythm except one patient with recurrent AF that was symptom free and refused the redo procedure. Quality of life improved significantly in all the patients and during final follow-up control all except two were off medication and in sinus rhythm (success rate = 96%). Left atrial dimensions decreased significantly after AF ablation (p<0.0001). D-dimer serum levels showed that the laser is not thrombogenic.
Conclusions By using the open-irrigated laser catheter RytmoLas® 1064nm Laser ablation is a tissue specific, non-contact, low power – short duration, normothermic, non-thrombogenic, ablation procedure, representing the safest and most effective long-term treatment of AF.
Dr Weber graduated 1962 at the University Victor Babeş, Timişoara, Rumania, relocated in Germany 1969, is an epidemiologist, specialist of Internal Medicine, consultant cardiologist, electrophysiology, specializing in cardiovascular laser catheter interventions. Worked at the Georg-August-University Göttingen, the Ludwig-Maximian-University Munich, and Central Laser Laboratory of the Helmholtz Center Munich. He is currently director of the Clinical Cardiac Electrophysiology Center Taufkirchen Department Research – Development – Education, Taufkirchen, Germany.
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