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.

• MeSH
• design vybavení * MeSH
• katetrizační ablace přístrojové vybavení   metody   MeSH
• komorová tachykardie diagnostické zobrazování   chirurgie   MeSH
• modely nemocí na zvířatech MeSH
• náhodné rozdělení MeSH
• nervus phrenicus zranění   MeSH
• peroperační komplikace prevence a kontrola   MeSH
• plocha pod křivkou MeSH
• prasata MeSH
• psi MeSH
• senzitivita a specificita MeSH
• srdeční katétry MeSH
• studie proveditelnosti MeSH
• zvířata MeSH
• Check Tag
• psi MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Pharmacology frequently fails for the treatment of epilepsy. Although surgical techniques are effective, these procedures are highly invasive. We describe feasibility and efficacy of minimally invasive mapping and ablation for the treatment of epilepsy. METHODS: Mapping and radiofrequency ablations were performed via the venous system in eleven baboons and three dogs. RESULTS: Mapping in deep cerebral areas was obtained in all animals. High-frequency pacing was able to induce seizure activity of local cerebral tissue in 72% of our attempts. Cerebral activity could be seen during mapping. Ablative lesions were deployed at deep brain sites without steam pops or sudden impedance rise. Histologic analysis showed necrosis at the sites of ablation in all primates. CONCLUSION: Navigation through the cerebral venous system to map seizure activity is feasible. Radiofrequency energy can be delivered transvenously or transcortically to successfully ablate cortical tissue in this animal model using this innovative approach.

• MeSH
• epilepsie patologie   patofyziologie   chirurgie   MeSH
• katetrizační ablace škodlivé účinky   přístrojové vybavení   metody   MeSH
• magnetické pole MeSH
• mapování mozku MeSH
• miniinvazivní chirurgické výkony škodlivé účinky   přístrojové vybavení   metody   MeSH
• modely nemocí na zvířatech MeSH
• mozková kůra krevní zásobení   patologie   patofyziologie   chirurgie   MeSH
• neurochirurgické výkony škodlivé účinky   přístrojové vybavení   metody   MeSH
• Papio MeSH
• psi MeSH
• studie proveditelnosti MeSH
• zvířata MeSH
• Check Tag
• psi MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH