Evaluation of different ablation strategies verifying the optimal overlap ratio in point-by-point laser balloon ablation for patients with atrial fibrillation

Background: Optimal overlap ratio remains unclear in point-by-point laser balloon (LB) ablation. Objective: This study sought to determine the optimal overlap strategy with target energies on the acute and chronic outcomes in LB pulmonary vein (PV) isolation (PVI). Methods: Consecutive 38 patients (148 PVs) with atrial fibrillation underwent the first-generation LB PVI with the following protocols based on the overlap ratios for each PV anterior/posterior wall: 50%/50% (13 patients [49 PVs], group A), 50%/25% (15 patients [60 PVs], group B), and 25%/25% (10 patients [39 PVs], group C). High energies (240–255 J: 12 W / 20 seconds, 8.5 W / 30 seconds), moderate energies (200–210 J: 10 W / 20 seconds, 7 W / 30 seconds), and low-to-moderate energies (low, 165–170 J: 5.5 W / 30 seconds, 8.5 W / 20 seconds) were targeted for left PV anterior walls, right PV anterior walls, and bilateral PV posterior walls, respectively. First-pass PVI, the other procedure-related data, and atrial tachyarrhythmia recurrences were analyzed. Results: First-pass PVI rate per PV was higher in group A (94%) than in group B (88%) and group C (62%) (P < .001). All PVs were finally isolated. First-pass time, total LB PVI time, complications, and atrial tachyarrhythmia recurrences during a mean follow-up of 11 ± 5 months did not differ between the groups. A few residual gaps after first-pass LB ablations were found for PV anterior walls even in group A and group B. Conclusion: Sufficiently overlapped LB ablation promises a high rate of first-pass PVI without adverse outcomes. High energy could be required for PV anterior walls.