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Direct Visualization of Epicardial Structures and Ablation Utilizing a Visually Guided Laser Balloon Catheter: Preliminary Findings

Authors


  • This work was supported in part by the M.G.H. Deane Institute for Integrative Research in Atrial Fibrillation and Stroke.

  • Conflict of Interest/Financial Disclosures reported: E.K. Heist: St. Jude Medical (consultant, honoraria, research grants), Boston Scientific (consultant, honoraria, research grants); C.Barrett: St. Jude Medical (research grants); J.N. Ruskin: Biosense Webster (consultant, fellowship support), Boston Scientific (fellowship support), CardioFocus (clinical oversight committee—no compensation), CardioInsight (scientific advisory board), CryoCath (scientific steering committee—no compensation), Medtronic (consultant, fellowship support), St. Jude Medical (fellowship support); M. Mansour: Cardiofocus (research grants), St. Jude Medical (research grants), Biosense-Webster (research grants). Other authors: No disclosures.

Moussa Mansour, M.D., Cardiac Arrhythmia Service and Cardiac Unit, Massachusetts General Hospital Gray 109, 55 Fruit St., Boston, MA 02114. Fax: 617-724-1241; E-mail: mmansour@partners.org

Abstract

Epicardial Laser Balloon Ablation. Background: Intrapericardial mapping and ablation can be utilized to target epicardial arrhythmic circuits. Current epicardial ablation strategies are associated with risk of damage to adjacent structures, including the coronary vasculature and phrenic nerves.

Objectives: The purpose of this study was to evaluate the feasibility of an investigational, visually guided laser balloon catheter for manipulation within the pericardial space, visualization of epicardial structures, and delivery of laser ablation lesions to the ventricular myocardium.

Methods: Pericardial access was obtained in 4 anesthetized swine by subxyphoid puncture. The laser balloon catheter was introduced into the pericardial space via a deflectable sheath, and was manipulated to predefined regions in all animals. Visually guided laser ablation was performed on the ventricular myocardium, with post mortem examination of lesion size and depth.

Results: The laser ablation catheter could be manipulated to all targeted regions in all animals. Associated structures, including epicardial coronary arteries and veins as well as an endocardial catheter in the left atrial appendage, were easily visualized. A total of 9 laser energy applications at varying power/time settings were performed. Ablation utilizing moderate (7–8.5 W) power produced relatively uniform lesions (diameter 5–12 mm, depth 6–9 mm), while high (14 W) power produced a visible “steam pop” with a large, hemorrhagic lesion (22 × 11 × 11 mm).

Conclusions: The investigational laser balloon catheter can be manipulated within the epicardial space, allowing for direct visualization of surrounding structures during ablation. Titration of laser power can be utilized to create moderate-sized ablation lesions while avoiding steam pops. (J Cardiovasc Electrophysiol, Vol. 22, pp. 808-812, July 2011)

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