Short title: Laser therapy
Claudio Tondo, MD, PhD, FESC, FHRS
Department of Electrophysiology&Cardiac Pacing
Centro Cardiologico Monzino, IRCCS
Department of Biomedical, Surgical and Dentist Sciences, University of
Milan, Milan, Italy.
Correspondence to:
Claudio Tondo, M.D., Ph.D., FESC, FHRS
Director, Department of Electrophysiology&Cardiac Pacing
Centro Cardiologico Monzino, IRCCS
Department of Biomedical, Surgical and Dentist Sciences
University of Milan, Milan, Italy
Via Carlo Parea, 4 - 20138 Milan, Italy
Mail: claudio.tondo@ccfm.it;
claudio.tondo@unimi.it
“Funding None”
“Conflict of Interest: None”
In this issue of the Journal Kuroki et al (1) explores the value of
semi-automated (SA) visually-guided laser ablation (VGLA) for pulmonary
vein isolation (PVI) in comparison with the more conventional manual
(MN) laser ablation. Laser- based PVI has been around for many years and
the main aim of this modality of ablation is to provide a continuous
circular overlapping lesions around the PVs’ ostia. In order to ensure
the continuity of the lesion, a camera is embedded in the system as to
guide the placement of sequential applications with the target to make
an adequate overlapping of two contiguous lesions as to reduce the
likelihood of gaps. The first version of the system required the
operator to manually rotate the catheter as to create a continuous arc
of lesion around the PV’s ostium.
The amount of energy delivered depends on the anatomic location, being
higher in the anterior portion of the ostium and less in the posterior,
so that the operator can properly titrate the application. This approach
is still time-consuming, since each application takes 20” to be
completed, thus a substantial overall time for each PV (2) The
evolvement of the technique has been recently offered, with a novel
semi-automated VGLA as to improve ablation efficiency by using a
motorized system which moves the laser arc continuously in order to
reduce the application time and, hopefully, minimize the creation of
gaps.