ABSTRACT
Background:
Catheter ablation (CA) is an effective
therapy for
atrial fibrillation (AF) and, although
radiofrequency ablation (RFA) is the standard
treatment for
pulmonary vein isolation (PVI), it is complex and
time-consuming.
Laser balloon ablation (LBA) has been introduced to simplify the conventional RFA; however, results of studies comparing LBA and RFA remain controversial. As such, this investigation aimed to comprehensively evaluate the
efficacy and
safety of LBA versus RFA.
Methods:
The
PubMed, Embase, Cochrane
Library, and ClinicalTrials.gov databases were searched for relevant studies. The primary endpoints were the
freedom from atrial
tachyarrhythmia (ATA) and
procedure-related
complications.
Results:
Twelve studies including 1274 subjects were included. LBA and RFA yielded
similar rates of
freedom from ATA (72.5% vs. 68.7%,
odds ratio [OR] = 1.26, 95%
confidence interval [CI] 1.0-1.7, p = 0.11) and
procedure-related
complications (7.7% vs. 6.5%, OR = 1.17, 95% CI 0.72-1.90, p = 0.536). LBA with the second- and third-generation
laser balloons (LB2/3) yielded remarkably higher rates of
freedom from ATA than RFA using contact-force
technology (RFA-CF) (OR = 1.91, p = 0.013). Significantly lower
pulmonary vein (PV) reconnection rates (OR = 0.51, p = 0.021), but higher
phrenic nerve palsy (PNP) rates (OR = 3.42, p = 0.023) were observed in the LBA group. LBA had comparable
procedure (weighted mean difference [WMD] = 8.43 min, p = 0.337) and
fluoroscopy times (WMD = 3.09 min, p = 0.174), but a longer ablation
time (WMD = 12.57 min, p = 0.00) than those for RFA.
Conclusions:
LBA and RFA
treatments were comparable in terms of
freedom from ATA and postprocedural
complications in
patients with AF. Compared with RFA, LBA was associated with significantly lower PV reconnection rates, but a higher
incidence of PNP and longer ablation
time.
