Linear Atrial Ablation With a Diode Laser and Fiberoptic Catheter
1999; Lippincott Williams & Wilkins; Volume: 100; Issue: 14 Linguagem: Inglês
10.1161/01.cir.100.14.e59
ISSN1524-4539
AutoresDavid Keane, Jeremy N. Ruskin,
Tópico(s)Cardiac pacing and defibrillation studies
ResumoHomeCirculationVol. 100, No. 14Linear Atrial Ablation With a Diode Laser and Fiberoptic Catheter Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBLinear Atrial Ablation With a Diode Laser and Fiberoptic Catheter David Keane and Jeremy N. Ruskin David KeaneDavid Keane From the Cardiac Unit, Massachusetts General Hospital, Boston. and Jeremy N. RuskinJeremy N. Ruskin From the Cardiac Unit, Massachusetts General Hospital, Boston. Originally published5 Oct 1999https://doi.org/10.1161/01.CIR.100.14.e59Circulation. 1999;100:e59–e60The catheter maze procedure for the treatment of chronic atrial fibrillation requires the creation of transmural, continuous linear atrial lesions. Attempts to drag a conventional radiofrequency ablation catheter across the atria in clinical as well as experimental studies have resulted in discontinuous lesions. Continuous linear lesions have been most difficult to create in trabeculated atrial muscle. Lesion discontinuities or gaps have resulted in reentrant atrial tachyarrhythmias in patients after ablation.We have explored the use of a linear laser catheter for the creation of continuous atrial lesions. A linear laser system may offer a number of potential advantages over conventional radiofrequency catheter ablation: (1) the laser diffuser is a single flexible and compliant fiber that can create thin lesions; (2) continuous intimate contact between the catheter and the endocardium may not be essential for delivery of laser energy; (3) the laser diffuser is Teflon coated, is not directly heated during energy delivery, and thus is not prone to char formation on the catheter; and (4) laser energy delivery is not subject to disruption by rises in impedance.We tested the feasibility of percutaneously creating a line of conduction block on the trabeculated anterior wall of the right atrium with a diode laser in a goat model.These images (Figure) demonstrate that linear atrial conduction block can be effectively achieved by catheter ablation with thermal energy sources other than conventional radiofrequency current.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Left, At baseline, a high-density electrode plaque (112 electrodes) was placed on the right atrial epicardial surface. An endocardial pacing catheter was placed on the medial border of the right atrial appendage, and an isochronal map was generated (Prucka) during paced atrial rhythm at a cycle length of 400 ms. Earliest activation is displayed in red and latest activation in blue. Activation can be seen to spread rapidly (arrow) from the pacing site across the atrium along the longitudinal axis of a pectinate muscle. Middle, An ablation catheter with a 4-cm cold diffuser tip (CardioFocus) was introduced via the right femoral vein and aligned under fluoroscopy in a superior-inferior axis on the endocardial surface of the right atrial free wall. The high-density electrode plaque was removed, and the anterior right atrial wall was imaged with an infrared camera through the right lateral thoracotomy. Heat generated during laser ablation on the endocardial surface can be seen on the infrared image to radiate through the atrial wall in a linear configuration throughout the length of 4-cm diffuser. Right, After laser ablation, the high-density plaque was again placed on the epicardial surface of the right atrium, and another isochronal map was generated during pacing from the same site as baseline. Activation of the atrium after laser catheter ablation now demonstrates that linear conduction block has been achieved and is aligned with the superior-inferior orientation of the laser catheter.FootnotesCorrespondence to David Keane, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, Fruit St, Boston, MA 02114. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited ByNazer B, Walters T, Duggirala S and Gerstenfeld E (2017) Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter, Circulation: Arrhythmia and Electrophysiology, 10:3, Online publication date: 1-Mar-2017. Sagerer-Gerhardt M and Weber H (2016) Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter, Lasers in Medical Science, 10.1007/s10103-016-1980-1, 31:7, (1333-1338), Online publication date: 1-Sep-2016. Splinter R (2015) Laser Catheter Ablation of Cardiac Arrhythmias: Experimental and Basic Research and Clinical Results Lasers in Cardiovascular Interventions, 10.1007/978-1-4471-5220-0_16, (199-219), . Horke A and Tzanavaros I (2014) Prävention und Behandlung von Herzrhythmusstörungen bei Patienten mit angeborenen HerzfehlernPrevention and treatment of cardiac arrhythmia in patients with congenital heart defects, Herzschrittmachertherapie + Elektrophysiologie, 10.1007/s00399-014-0334-6, 25:3, (188-197), Online publication date: 1-Sep-2014. Doshi S and Keane D (2011) Catheter Microwave, Laser, and Ultrasound Catheter Ablation of Cardiac Arrhythmias, 10.1016/B978-1-4377-1368-8.00005-2, (58-71), . Sra J and Akhtar M (2007) Mapping Techniques for Atrial Fibrillation Ablation, Current Problems in Cardiology, 10.1016/j.cpcardiol.2007.09.002, 32:12, (669-767), Online publication date: 1-Dec-2007. IV H, Dumas J, Kiser A and Knisley S (2007) Translesion stimulus-excitation delay indicates quality of linear lesions produced by radiofrequency ablation in rabbit hearts, Physiological Measurement, 10.1088/0967-3334/28/6/001, 28:6, (611-623), Online publication date: 1-Jun-2007. YIU K, LAU C, LEE K and TSE H (2006) Emerging Energy Sources for Catheter Ablation of Atrial Fibrillation, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2006.00633.x, 17:s3, (S56-S61), Online publication date: 1-Dec-2006. Hornero F (2006) Atrial Fibrillation and Atrial Flutter Wiley Encyclopedia of Biomedical Engineering, 10.1002/9780471740360.ebs1457 Montenero A and Andrew P (2014) Current treatment options for atrial flutter and results with cryocatheter ablation, Expert Review of Cardiovascular Therapy, 10.1586/14779072.4.2.191, 4:2, (191-202), Online publication date: 1-Mar-2006. Asaumi Y, Watanabe G, Nagamine H and Tomita S (2006) An Innovative Balloon-Type Surgical Device for Atrial Fibrillation, The Heart Surgery Forum, 10.1532/HSF98.20041141, 9:1, (E480-E485), Online publication date: 1-Feb-2006. Ndrepepa G and Estner H Ablation of cardiac arrhythmias — energy sources and mechanisms of lesion formation Catheter Ablation of Cardiac Arrhythmias, 10.1007/3-7985-1576-X_2, (35-53) Sie H, Beukema W, Elvan A and Misier A (2007) Surgical Ablation Therapy II: Endocardium-Based Catheter Ablation Innovative Management of Atrial Fibrillation, 10.1002/9780470994818.ch10, (138-145) CUMMINGS J, PACIFICO A, DRAGO J, KILICASLAN F and NATALE A (2005) Alternative Energy Sources for the Ablation of Arrhythmias, Pacing and Clinical Electrophysiology, 10.1111/j.1540-8159.2005.09481.x, 28:5, (434-443), Online publication date: 1-May-2005. Fahey B, Nightingale K, McAleavey S, Palmeri M, Wolf P and Trahey G Acoustic radiation force impulse imaging of myocardial radiofrequency ablation: initial in vivo results, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control, 10.1109/TUFFC.2005.1428046, 52:4, (631-641) Patanè L and Cavallaro A Advances in Surgical Treatment of Atrial Fibrillation Emerging Pathologies in Cardiology, 10.1007/88-470-0341-5_17, (135-151) Magnano A, Woollett I and Garan H (2004) Percutaneous Catheter Ablation Procedures for the Treatment of Atrial Fibrillation, Journal of Cardiac Surgery, 10.1111/j.0886-0440.2004.04035.x, 19:3, (188-195), Online publication date: 1-May-2004. Bonso A, Themistoclakis S, Rossillo A and Raviele A (2004) Atrial Fibrillation: Catheter Laser Balloon Ablation Cardiac Arrhythmias 2003, 10.1007/978-88-470-2137-2_23, (173-176), . Berul C (2003) Electrophysiological phenotyping in genetically engineered mice, Physiological Genomics, 10.1152/physiolgenomics.00183.2002, 13:3, (207-216), Online publication date: 13-May-2003. Skanes A, Klein G, Krahn A and Yee R (2003) Advances in energy delivery, Coronary Artery Disease, 10.1097/00019501-200302000-00003, 14:1, (15-23), Online publication date: 1-Feb-2003. Calkins H (2001) Catheter Ablation for Cardiac Arrhythmias, Medical Clinics of North America, 10.1016/S0025-7125(05)70323-0, 85:2, (473-502), Online publication date: 1-Mar-2001. Fried N, Tsitlik A, Rent K, Berger R, Lardo A, Calkins H and Halperin H (2001) Laser ablation of the pulmonary veins by using a fiberoptic balloon catheter: Implications for treatment of paroxysmal atrial fibrillation, Lasers in Surgery and Medicine, 10.1002/lsm.1038, 28:3, (197-203), . Fried N, Lardo A, Berger R, Calkins H and Halperin H (2000) Linear lesions in myocardium created by Nd:YAG laser using diffusing optical fibers: In vitro and in vivo results, Lasers in Surgery and Medicine, 10.1002/1096-9101(2000)27:4 3.0.CO;2-T, 27:4, (295-304), . October 5, 1999Vol 100, Issue 14 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/01.CIR.100.14.e59 Originally publishedOctober 5, 1999 PDF download Advertisement
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