Cardiac Electrophysiology Review

, Volume 6, Issue 4, pp 341–348 | Cite as

New Catheter Ablation Techniques for the Treatment of Cardiac Arrhythmias

  • David Keane
Article

Abstract

Although established as the current standard in catheter ablation, radiofrequency energy has significant limitations. To produce a continuous line of conduction block, radiofrequency energy requires contact between the electrode and endocardium throughout and produces a lesion limited in depth and prone to endocardial disruption. As the predominant case mix of catheter ablation shifts from supraventricular tachycardias towards atrial fibrillation and ventricular tachycardia, interest has grown in alternative energy sources.

Cryothermy offers the advantages of low risk of endocardial disruption and thrombus formation with extensive previous surgical experience in the treatment of cardiac arrhythmias. Ultrasound and microwave have the advantages of being contact forgiving and having excellent depth of penetration without an apparent higher risk of endocardial disruption than radiofrequency. Diode laser produces controlled low energy ablation and can be delivered through a range of optical fiber configurations including loops and balloons to produce thin continuous lesions. The use of optical fibers for laser delivery also provides an option for reflectance spectroscopy as a feedback mechanism on both contact as well as lesion progression in real time. Each of the above energy sources have potential clinical advantages in epicardial as well as endocardial ablation.

catheter ablation cardiac arrhythmia laser microwave cryothermy ultrasound new technologies 

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References

  1. 1.
    Zhou L, Keane D, Reed G, Ruskin J. Thromboembolic risks of cardiac radiofrequency cahteter ablation. J Cardiovasc Electrophysiol 1999;4:611–620.Google Scholar
  2. 2.
    Ohkubo T, Okishige K, Goseki Y, Matsubara T, Hiejima K, Ibukiyama C. Experimental study of catheter ablation using ultrasound energy in canine and porcine hearts. Jpn Heart J 1998;39:399–409.Google Scholar
  3. 3.
    He DS, Zimmer JE, Hynynen K, Marcus FI, Caruso AC, Lampe LF, Aguirre ML. Application of ultrasound energy for intracardiac ablation of arrhythmias. Eur Heart J 1995;16:961–966.Google Scholar
  4. 4.
    Natale A, Pisano E, Shewchik J, Bash D, Fanelli R, Potenza D, Santarelli P, Schweikert R, White R, Saliba W, Kanagaratnam L, Tchou P, Lesh M. First human experience with pulmonary vein isolation using a throughthe-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation 2000;102:1879–1882.Google Scholar
  5. 5.
    Lee BI, Gottdiener JS, Fletcher RD, Rodriguez ER, Ferrans VJ. Transcatheter ablation: Comparison between laser photoablation and electrode shock ablation in the dog. Circulation 1985;71:579–586.Google Scholar
  6. 6.
    Saksena S, Gielchinsky I, Tullo NG. Argon laser ablation of malignant ventricular tachycardia associated with coronary artery disease. Am J Cardiol 1989;64:1298–1304.Google Scholar
  7. 7.
    Pfeiffer D, Moosdorf R, Svenson RH, Littmann L, Grimm W, Kirchhoff PG, Luderitz B. Epicardial neodymium. YAG laser photocoagulation of ventricular tachycardia without ventriculotomy in patients after myocardial infarction. Circulation 1996;94:3221–3225.Google Scholar
  8. 8.
    Ware DL, Boor P, Yang C, Gowda A, Grady JJ, Motamedi M. Slow intramural heating with diffused laser light: A unique method for deep myocardial coagulation. Circulation 1999;99:1630–1636.Google Scholar
  9. 9.
    Keane D, Ruskin JN. Linear atrial ablation with a diode laser and fiberoptic catheter. Circulation 1999;100:e59–e60.Google Scholar
  10. 10.
    Fried NM, Lardo AC, Berger RD, Calkins H, Halperin HR. Linear lesions in myocardium created by Nd: YAG laser using diffusing optical fibers: In vitro and in vivo results. Lasers Surg Med 2000;27:295–304.Google Scholar
  11. 11.
    Reddy V, Houghtaling C, Fischer G, Keane D, Ruskin J. Isolation of caprine pulmonary veins using a diode laser balloon catheter. PACE 2002;24(PtII):552(abstr).Google Scholar
  12. 12.
    Johnson S, Su W, Da Salva LL, Packer DL. Power-dependence of laser energy in circumferential ablation of pulmonary veins. PACE 2002;24(PtII):552(abstr).Google Scholar
  13. 13.
    Whayne JG, Nath S, Haines D. Microwave catheter ablation of myocardium in vitro. Assessment of the characteristics of tissue heating and injury. Circulation 1994;89:2390–2395.Google Scholar
  14. 14.
    Knaut M, Tugtekin M, Spitzer SG, Karolyi L, Boehme H, Schueler S. Curative treatment of chronic atrial fibrillation in patients with simultaneous cardiosurgical diseases with intraoperative microwave ablation. JACC 2001;109A(abstr).Google Scholar
  15. 15.
    Kubota H, Takamoto S, Maeda K, Ninomiya M, Ueno K, Kotsuka Y. Beating MAZE procedure using an infrared coagulator: To heat to beat. J Am Coll Cardiol 2001:109A(abstr).Google Scholar
  16. 16.
    Whittaker DK. Mechanisms of tissue destruction following cryosurgery. Annals of the Royal College of Surgeons of England 1984;66(5):313–318.Google Scholar
  17. 17.
    Lustgarten D, Keane D, Ruskin J. Cryothermal catheter ablation: Mechanism of tissue injury and clinical results. Prog Cardiovasc Dis 1999;41:481–498.Google Scholar
  18. 18.
    Holman WL, Ikeshita M, Lease JG, Smith PK, Lofland GK, Cox JL. Cryosurgical modification of retrograde atrioventricular conduction. Implications for the surgical treatment of atrioventricular nodal reentry tachycardia. J Thorac Cardiovasc Surg 1986;91(6):826–834.Google Scholar
  19. 19.
    Cox J, Holman W, Cain W. Cryosurgical treatment of atrioventricular node reentrant tachycardia. Circulation 1987;76(6):1329–1336.Google Scholar
  20. 20.
    Dubuc M, Roy D, Thibault B, Ducharme A, Tardif JC, Villemaire C, Leung TK, Talajic M. Transvenous catheter ice mapping and cryoablation of the atrioventricular node in dogs. PACE 1999;22:1488–1498.Google Scholar
  21. 21.
    Friedman P, Stevenson WG, Tchou PJ, Wharton JM, Keane DTJ, Skanes A, Dubuc M. Reversible cryomapping of the slow pathway during catheter cryoablation of atrioventricular nodal reentrant supraventricular tachycardia. Circ 2000;II-368(abstr).Google Scholar
  22. 22.
    Keane D, Zhou L, Houghtaling C, Aretz T, McGovern B, Garan H, Ruskin J. Percutaneous cryothermal catheter ablation for the creation of linear atrial lesions. PACE 1999:22(II):587.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • David Keane
    • 1
  1. 1.Massachusetts General HospitalBostonUSA

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