Endoscopic Ablation System Treats Paroxysmal Atrial Fibrillation

The system is based on a near infrared (NIR) laser light and a deflectable sheath that provides efficient transseptal access for ablation of all four pulmonary veins. The sheath is first used to transport a catheter to the vicinity of the vein using fluoroscopy, whereupon the compliant balloon is inflated. Once tissue contact is achieved, an integral micro-endoscope is used to visualize the placement of the balloon relative to the ostium of the vein.

The physician then uses the endoscopic image acquired by direct visualization to determine placement of each arc of NIR laser light, in order to place overlapping arcs into the atrial wall around each vein. The endoscope also provides feedback on progress obtained in achieving vein isolation via a dynamic view of the developing lesions on the cardiac tissue. The scar tissue creates a conduction block with just several 20-30 second energy deliveries. The HeartLight system is a product of CardioFocus (Marlborough, MA, USA), and has been approved by the US Food and Drug Administration (FDA).

“Based on our experience in the CardioFocus pivotal study and the successful results from the European Union, I am confident that this new laser balloon catheter will offer our patients an outstanding treatment option for atrial fibrillation,” said Frank Cuoco, MD, of the Medical University of South Carolina (Charleston, SC, USA). “The flexibility of the compliant balloon, which is intuitive to use under direct visual guidance, is one of its primary appeals. I found the learning curve to be very short.”

PVI is a catheter ablation technique developed to prevent focal triggers in the pulmonary veins from initiating episodes of AF. Although the procedure initially involved focal ablation with a catheter directly in the pulmonary veins, applying ablation energy at their junction with the left atrium is more effective. The PVI procedure is most suitable for patients whose recurring symptomatic episodes of AF that have not been suppressed by anti-arrhythmic drugs, or who do not wish to take long- term anti-arrhythmic or anticoagulation medications.

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