Co-Author(s):
Natalia Martin, CEPS, CCDS
Florida Heart Rhythm Specialists
1841 NE 45th Street, Ft. Lauderdale, FL 33308
Introduction | Objectives: The endoscopic ablation system (EAS) utilizes a laser balloon to
provide pulmonary vein isolation (PVI) in patients with atrial
fibrillation (AF). The X3 EAS is the newest generation employing a motor
to provide an option for contiguous circumferential lesion delivery in
the RAPID mode.
Methods: 75 consecutive AF patients were treated. After single transseptal
puncture, a 12F delivery sheath was positioned in the LA (left atrium).
A 3D enabled circular mapping catheter was used to record PV (pulmonary
vein) potentials and create an electroanatomic map of the LA. The EAS
was inflated to obtain optimal circumferential contact with the PV
antrum. Ideally, RAPID mode ablation was employed at 13-15W. In case of
esophageal heating >39°C or suboptimal tissue exposure,
point-by-point ablation (5.5-12W for 20-30s) was used. During ablation
of the right PVs, phrenic nerve pacing was performed via a diagnostic
catheter.
Single shot ablation was defined as one single RAPID energy application
per PV to complete the singular, circular lesion set. PV conduction was
re-assessed with 3D mapping after all PVs had been treated. In case of
residual PV conduction, gap mapping followed by EAS guided ablation was
performed.
Procedure time was defined as initial groin puncture to withdrawal of
the X3 EAS catheter. LA treatment time was defined by transseptal
puncture to withdrawal of the X3 EAS catheter.
Results: 75 AF patients (68.1% male, mean age 64.6 + 11.4 years, 89.33%
paroxysmal) with 298 PVs underwent X3 EAS ablation. Of the 298 PVs
attempted, 298 (100%) were isolated with X3 EAS and in 270/298
(90.6%), PVs were isolated first pass. The median procedure time was
82.0 (45.0, 185.0) minutes with a median LA time of 69.0 (36.0, 173.0)
minutes. The median fluoroscopy time was 6.0 (1.1, 17.6) minutes. No
acute phrenic nerve injury, pericardial effusion or pericardial
tamponade occurred in this cohort.
Conclusions: The X3 EAS catheter with RAPID mode achieved acute isolation in 100%
of all PVs with a 90.6% first pass isolation rate and a substantially
faster procedure time (82.0 minutes) compared to previous EAS
generations. Procedure, LA and fluoroscopy times decreased as user
experience increased.
AFS 2021-29
Uploaded File(s) Table 1