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Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter

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Abstract

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.

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Abbreviations

ECG:

Electrocardiography

EGM:

Electrogram

ICE:

Intracardiac echocardiography

IVUS:

Intravascular ultrasound

RF:

Radiofrequency

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

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Funding

Funding support is provided by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR) and by project FNUSA-ICRC no. CZ.1.05/1.1.00/02.0123 (OP VaVpI). CVD was supported by an NIH T32 training grant (HL007111), European Union Agreement—St. Anne’s University Hospital Brno.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

    Ammar M. Killu, Niyada Naksuk, Faisal F. Syed, Christopher V. DeSimone, Chance Witt, Charles J. Bruce, Paul A. Friedman & Samuel J. Asirvatham

  2. Mayo Medical School, Rochester, MN, USA

    Prakriti Gaba

  3. Mayo Clinic Ventures, Mayo Clinic, Rochester, MN, USA

    Dorothy J. Ladewig, Joanne M. Powers & Gaurav Satam

  4. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Scott H. Suddendorf

  5. International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

    Zdeněk Stárek, Tomas Kara, Jiří Wolf, Pavel Leinveber & Miroslav Novák

  6. Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic

    Michal Crha

  7. Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Samuel J. Asirvatham

Authors
  1. Ammar M. Killu
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  2. Niyada Naksuk
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  16. Miroslav Novák
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  19. Samuel J. Asirvatham
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Corresponding author

Correspondence to Samuel J. Asirvatham.

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Conflict of interest

Mayo Clinic owns intellectual property related to the investigated technology reported in the manuscript. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with Mayo Clinic Conflict of Interest policies.

Ethical approval

The study was approved by the Mayo Clinic Institutional Animal Care and Use Committee (IACUC) and the Ethics Committee of the University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic.

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Killu, A.M., Naksuk, N., Syed, F.F. et al. Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter. J Interv Card Electrophysiol 53, 105–113 (2018). https://doi.org/10.1007/s10840-018-0404-5

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  • DOI: https://doi.org/10.1007/s10840-018-0404-5

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