Balloons and atrial fibrillation
This excellent short review article (1)is written by someone who has a self declared interest in the manufacturer of the "laser balloon" (Cardiofocus Inc, 500 Nickerson Road, Suite 500-200. Marlborough, Massachusetts). It is unsurprising therefore to see that he gives the cryoballoon, a rival technology, short shrift by dismissing it as "having problems". In fact there are published data showing that it is probably the most successful approach to PAF so-far invented (2). Acute success was achieved in over 98% of 924 patients. The one year freedom from PAF rate is over 70% discounting recurrences inside a 3 month blanking period. Clinical pulmonary vein stenosis was 0.17%. Persistent phrenic nerve palsy beyond 1 year occurred in only 0.37%. It is also a very simple technique not involving any ancillary technology such as angioscopy and no additional certification is required (In the UK laser training and certification of both operator and laboratory is usually necessary to use laser equipment). Also oesophageal temperature monitoring and power adjustments are unnecessary. The simplicity of the technique has seen an enthusiastic and growing uptake of the cryoballoon and several thousand procedures have now been performed. The cryoballoon has brought PAF in from the cold and is unlikely to be displaced in the near future by the laser balloon which still does not have an established position in modern cardiology. However, further studies are needed comparing, for example, equipment costs, effectiveness, clinical outcomes, complications and procedure durations.
References (1) Gerstenfeld EP. Have lasers finally found their niche in interventional cardiology? Heart doi:10.1136/heartjnl-2011-301358
(2) Andrade JG, Khairy P, Guerra PG et al. Efficacy and safety of cryoballoon ablation for atrial fibrillation; a systematic review of published studies. Heart Rhythm 2011:8; 1444-51
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