HeartLight Guided - Pure Pulmonary Vein Isolation Regardless of Concomitant Atrial Substrate (HEURECA)

Aim of the present prospective, single-centre study is to determine the outcome after pure PVI using HeartLight™ in 100 patients with different extents of LA-LVA. The latter will be assessed by an electro-anatomical voltage map using a commercial 3D mapping system (CARTO, Biosense Webster).

The ablation strategy for patients with atrial fibrillation (AF) and concomitant atrial substrate (e.g. low-voltage areas; LVA) is a matter of controversy. Results of studies investigating the impact of LVA may have been confounded by PV-to-left-atrial (LA) reconnection due to non-durable ablation. Therefore, the true contribution of LA-LVA to AF recurrences remains unknown. Meanwhile, new ablation technologies such as the HeartLight™ laser balloon (LB) ablation system providing near complete chronic PVI rates have been developed. Aim of the present prospective, single-centre study is to determine the outcome after pure PVI using HeartLight™ in 100 patients with different extents of LA-LVA. The latter will be assessed by an electro-anatomical voltage map using a commercial 3D mapping system (CARTO, Biosense Webster).

72h Holter-ECG recordings will be performed. In case of clinical arrhythmia symptoms event-recording will be provided.

Inclusion Criteria: Symptomatic atrial fibrillation Left atrial size <50mm Left ventricular ejection fraction <45% Patient is able to provide informed consent Exclusion Criteria: Contraindications for PVI Previous PVI attempts Inability to be treated with oral anticoagulation Presence of intracardiac thrombi Pregnancy Participation in other clinical studies Unwilling to follow the study protocol and to attend follow-up visits