Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter
Language English Country Netherlands Media print-electronic
Document type Journal Article
Grant support
HL007111
National Institutes of Health
LQ1605
National Program of Sustainability
CZ.1.05/1.100/02.0123
FNUSA-ICRC
PubMed
30008046
DOI
10.1007/s10840-018-0404-5
PII: 10.1007/s10840-018-0404-5
Knihovny.cz E-resources
- Keywords
- Ablation, Epicardial, Insulation, Pericardial, Phrenic nerve, Scar,
- MeSH
- Equipment Design * MeSH
- Catheter Ablation instrumentation methods MeSH
- Tachycardia, Ventricular diagnostic imaging surgery MeSH
- Disease Models, Animal MeSH
- Random Allocation MeSH
- Phrenic Nerve injuries MeSH
- Intraoperative Complications prevention & control MeSH
- Area Under Curve MeSH
- Swine MeSH
- Dogs MeSH
- Sensitivity and Specificity MeSH
- Cardiac Catheters MeSH
- Feasibility Studies MeSH
- Animals MeSH
- Check Tag
- Dogs MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
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.
Department of Cardiovascular Diseases Mayo Clinic Rochester MN USA
Department of Cardiovascular Surgery Mayo Clinic Rochester MN USA
Department of Pediatrics and Adolescent Medicine Mayo Clinic Rochester MN USA
International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic
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