Is the energy source or the technique the “game changer”?
Point-by-point RF ablation has been the main ablation modality to achieve PVI and is still extensively applied in several EP laboratories. Needless to say that it relies on the operator’s skill and can be time-consuming. The advent of balloon-based platform devices has been very welcomed, since the manipulation of the catheter is reduced, the learning curve for operators is pretty simple and fast and most importantly the clinical outcome is not significantly different from the conventional RF ablation (3). The use of balloon platforms has then gained popularity in the EP community, leading to a more extensive use in several EP Labs with an improved patient workflow. Keeping this in mind, VGLA belongs to this family of ablative approach. As compared to other balloon-based design catheters, VGLA offers the beauty to view the atrial tissue and, thus, theoretically to better and properly deploy the lesions.
One could raise the question whether is the energy source or the ability to a have a clear vision of the tissue the turning point for a more efficient ablation. In this regard, we diligently need to refer to the recent data collected in clinical studies comparing VGLA with point-by-point RF and cryoenergy ablation. A randomized clinical study comparing the laser balloon with RF in 353 paroxysmal AF patients showed longer procedure and fluoroscopic times (236±53 vs 193±64 min, P<0.0001, and 36±18 vs 30±21 min, P=0.006) with 98% acute efficacy for PVI and an equal 12-months freedom of any atrial arrhythmias around 61% (3).
In more detail, laser ablation showed more diaphragmatic paralysis (6 vs 1) but fewer PV stenosis > 50% (0 vs 5). Furthermore, a recent European multicenter study (4) comparing the laser balloon with the cryoballoon showed that the procedure but not fluoroscopy time was significantly longer (96±20 vs 51±21 min, P<0.0001, and 8.4±3.2 vs 7.4±4.4 min, P=0.083), while efficacy close to 80% was the same for both procedures, and cryoballoon ablation was associated with a tendency of more transient phrenic nerve palsy (8 vs 2 cases). Based upon this clinical information, it appears that whatever energy source is chosen, the outcome is fairly comparable.