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 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.