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