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Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter

AM. Killu, N. Naksuk, FF. Syed, CV. DeSimone, P. Gaba, C. Witt, DJ. Ladewig, SH. Suddendorf, JM. Powers, G. Satam, Z. Stárek, T. Kara, J. Wolf, P. Leinveber, M. Crha, M. Novák, CJ. Bruce, PA. Friedman, SJ. Asirvatham,

. 2018 ; 53 (1) : 105-113. [pub] 20180714

Language English Country Netherlands

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc19035125

Grant support
HL007111 National Institutes of Health
LQ1605 National Program of Sustainability
CZ.1.05/1.100/02.0123 FNUSA-ICRC

E-resources Online Full text

NLK ProQuest Central from 1997-07-01 to 1 year ago
Medline Complete (EBSCOhost) from 2011-01-01 to 1 year ago
Health & Medicine (ProQuest) from 1997-07-01 to 1 year ago

Links

PubMed 30008046
DOI 10.1007/s10840-018-0404-5
Knihovny.cz E-resources

PURPOSE: To demonstrate the feasibility of directional percutaneous epicardial ablation using a partially insulated catheter. METHODS: Partially insulated catheter prototypes were tested in 12 (6 canine, 6 porcine) animal studies in two centers. Prototypes had interspersed windows to enable visualization of epicardial structures with ultrasound. Epicardial unipolar ablation and ablation between two electrodes was performed according to protocol (5-60 W power, 0-60 mls/min irrigation, 78 s mean duration). RESULTS: Of 96 epicardial ablation attempts, unipolar ablation was delivered in 53.1%. Electrogram evidence of ablation, when analyzable, occurred in 75 of 79 (94.9%) therapies. Paired pre/post-ablation pacing threshold (N = 74) showed significant increase in pacing threshold post-ablation (0.9 to 2.6 mA, P < .0001). Arrhythmias occurred in 18 (18.8%) therapies (11 ventricular fibrillation, 7 ventricular tachycardia), mainly in pigs (72.2%). Coronary artery visualization was variably successful. No phrenic nerve injury was noted during or after ablation. Furthermore, there were minimal pericardial changes with ablation. CONCLUSIONS: Epicardial ablation using a partially insulated catheter to confer epicardial directionality and protect the phrenic nerve seems feasible. Iterations with ultrasound windows may enable real-time epicardial surface visualization thus identifying coronary arteries at ablation sites. Further improvements, however, are necessary.

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