Laser light in the era of pulsed field ablation — still a competitor?

Excerpt

Cardiac catheter ablation procedures especially pulmonary vein isolation (PVI), as the currently most effective treatment option for atrial fibrillation (AF), are complex procedures with a relatively long learning curve. To reduce complexity and to improve safety, efficacy and efficiency single-shot devices have been introduced and shown promising acute and long-term success rates in numerous registries, studies, and randomized controlled clinical trials.1 Various catheter designs and energy sources have been evaluated in latest years, with the cryoballoon (CB) as the most common single-shot device with high level of clinical evidence [1]. Nevertheless, single-shot devices with a fixed size like the cryoballoon and the radiofrequency balloon have several limitations because the pulmonary vein anatomy strongly varies across patients [2, 3]. The visually guided laser balloon ablation system (HeartLight, CardioFocus, Marlborough, MA, USA) is a balloon-based ablation system which is utilizing laser light energy for lesion formation. Its design has been modified and optimized to its current version (X3, CardioFocus) and has been shown high PVI durability and similar clinical success compared to radiofrequency- and CB-based PVI [4, 5]. The X3 system offers a continuous sizeable balloon diameter and an automated continuous lesion formation [5]. …