Laser balloon ablation of atrial fibrillation in a patient with a large common inferior trunk: a case report

Abstract

Background

A balloon-based visually guided laser balloon (LB) ablation (LBA) is as effective and safe as radiofrequency ablation and cryoballoon ablation in curing patients with atrial fibrillation (AF). The third-generation LB is so compliant that it can be inflated to any pressure and size change of up to 41 mm with its maximal expansion, which enables maximum balloon/tissue contact regardless of the size or shape of each pulmonary vein (PV) ostium. A large common inferior trunk (CIT) with a structured, completely independent common ostium of both the right and the left inferior PVs completely conjoined prior to the junction with the left atrium is an extremely rare anatomical variant and an important triggering focus in paroxysmal AF.

Case summary

We present a case of an LBA of AF in a patient with a large CIT of 34 mm in diameter. The laser energy was individually deployed to the right-sided and left-sided antra of the large CIT with the LB positioned at the ostium of the CIT’s right and left branches. The complete electrical isolation of the three PVs was achieved. The patient remained stable without any symptoms or AF recurrence 1 year post ablation.

Discussion

The LBA, which is individually deployed to the right-sided and left-sided antra of the large CIT with the third-generation LB positioned at the ostium of the right and left branches of the CIT without laser energy deployment to the posterior wall of the CIT, may be one of the effective strategies for patients with large CITs.