Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach
Background Current thermal ablation methods for atrial fibrillation, including radiofrequency and cryoablation, have a suboptimal success rate. To avoid pulmonary vein (PV) stenosis, ablation is performed outside of the PV, despite the importance of triggers inside the vein. We previously reported o...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009575 |
| _version_ | 1811332369265721344 |
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| author | Chance M. Witt Alan Sugrue Deepak Padmanabhan Vaibhav Vaidya Sarah Gruba James Rohl Christopher V. DeSimone Ammar M. Killu Niyada Naksuk Joanne Pederson Scott Suddendorf Dorothy J. Ladewig Elad Maor David R. Holmes Suraj Kapa Samuel J. Asirvatham |
| author_facet | Chance M. Witt Alan Sugrue Deepak Padmanabhan Vaibhav Vaidya Sarah Gruba James Rohl Christopher V. DeSimone Ammar M. Killu Niyada Naksuk Joanne Pederson Scott Suddendorf Dorothy J. Ladewig Elad Maor David R. Holmes Suraj Kapa Samuel J. Asirvatham |
| author_sort | Chance M. Witt |
| collection | DOAJ |
| description | Background Current thermal ablation methods for atrial fibrillation, including radiofrequency and cryoablation, have a suboptimal success rate. To avoid pulmonary vein (PV) stenosis, ablation is performed outside of the PV, despite the importance of triggers inside the vein. We previously reported on the acute effects of a novel direct current electroporation approach with a balloon catheter to create lesions inside the PVs in addition to the antrum. In this study, we aimed to determine whether the effects created by this nonthermal ablation method were associated with irreversible lesions and whether PV stenosis or other adverse effects occurred after a survival period. Methods and Results Initial and survival studies were performed in 5 canines. At the initial study, the balloon catheter was inflated to contact the antrum and interior of the PV. Direct current energy was delivered between 2 electrodes on the catheter in ECG‐gated 100 μs pulses. A total of 10 PVs were treated demonstrating significant acute local electrogram diminution (mean amplitude decrease of 61.2±19.8%). After the survival period (mean 27 days), computed tomography imaging showed no PV stenosis. On histologic evaluation, transmural, although not circumferential, lesions were seen in each treated vein. No PV stenosis or esophageal injury was present. Conclusions Irreversible, transmural lesions can be created inside the PV without evidence of stenosis after a 27‐day survival period using this balloon‐based direct current ablation approach. These early data show promise for an ablation approach that could directly treat PV triggers in addition to traditional PV antrum ablation. |
| first_indexed | 2024-04-13T16:35:50Z |
| format | Article |
| id | doaj.art-0a91b89aafd94f22829a0ddbeb1f83a3 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:35:50Z |
| publishDate | 2018-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0a91b89aafd94f22829a0ddbeb1f83a32022-12-22T02:39:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-07-0171410.1161/JAHA.118.009575Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation ApproachChance M. Witt0Alan Sugrue1Deepak Padmanabhan2Vaibhav Vaidya3Sarah Gruba4James Rohl5Christopher V. DeSimone6Ammar M. Killu7Niyada Naksuk8Joanne Pederson9Scott Suddendorf10Dorothy J. Ladewig11Elad Maor12David R. Holmes13Suraj Kapa14Samuel J. Asirvatham15Department of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNBoston Scientific St. Paul MNBoston Scientific St. Paul MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDivision of Surgery Research Mayo Clinic Rochester MNDivision of Surgery Research Mayo Clinic Rochester MNMayo Clinic Ventures Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNBackground Current thermal ablation methods for atrial fibrillation, including radiofrequency and cryoablation, have a suboptimal success rate. To avoid pulmonary vein (PV) stenosis, ablation is performed outside of the PV, despite the importance of triggers inside the vein. We previously reported on the acute effects of a novel direct current electroporation approach with a balloon catheter to create lesions inside the PVs in addition to the antrum. In this study, we aimed to determine whether the effects created by this nonthermal ablation method were associated with irreversible lesions and whether PV stenosis or other adverse effects occurred after a survival period. Methods and Results Initial and survival studies were performed in 5 canines. At the initial study, the balloon catheter was inflated to contact the antrum and interior of the PV. Direct current energy was delivered between 2 electrodes on the catheter in ECG‐gated 100 μs pulses. A total of 10 PVs were treated demonstrating significant acute local electrogram diminution (mean amplitude decrease of 61.2±19.8%). After the survival period (mean 27 days), computed tomography imaging showed no PV stenosis. On histologic evaluation, transmural, although not circumferential, lesions were seen in each treated vein. No PV stenosis or esophageal injury was present. Conclusions Irreversible, transmural lesions can be created inside the PV without evidence of stenosis after a 27‐day survival period using this balloon‐based direct current ablation approach. These early data show promise for an ablation approach that could directly treat PV triggers in addition to traditional PV antrum ablation.https://www.ahajournals.org/doi/10.1161/JAHA.118.009575animal studyatrial fibrillationdirect current ablationelectroporationpulmonary vein stenosis |
| spellingShingle | Chance M. Witt Alan Sugrue Deepak Padmanabhan Vaibhav Vaidya Sarah Gruba James Rohl Christopher V. DeSimone Ammar M. Killu Niyada Naksuk Joanne Pederson Scott Suddendorf Dorothy J. Ladewig Elad Maor David R. Holmes Suraj Kapa Samuel J. Asirvatham Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease animal study atrial fibrillation direct current ablation electroporation pulmonary vein stenosis |
| title | Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach |
| title_full | Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach |
| title_fullStr | Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach |
| title_full_unstemmed | Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach |
| title_short | Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach |
| title_sort | intrapulmonary vein ablation without stenosis a novel balloon based direct current electroporation approach |
| topic | animal study atrial fibrillation direct current ablation electroporation pulmonary vein stenosis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009575 |
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