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A Novel Catheter Design for Laser Photocoagulation of the Myocardium to Ablate Ventricular Tachycardia

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Abstract

Nd:YAG laser energy has been proposed as an alternative to radiofrequency energy for ablation of ventricular tachycardia (VT) associated with coronary artery disease (CAD) in an effort to increase lesion size and success rates. However, issues of catheter design to maintain flexibility and ensure adequate tissue contact have hindered development of laser catheters.

We developed and tested a prototype 8 Fr. steerable catheter with a flexible and extendible tip (designed to ensure tissue contact and efficient ventricular mapping), which projects the laser beam through a side port containing a lens-tipped optical fiber that rests against the endocardial surface. The catheter has a channel for simultaneous saline irrigation to displace the interceding blood and discharge a laser beam between two electrodes for bipolar mapping and a thermocouple for temperature monitoring. The catheter was tested on bench top using the epicardial surface of freshly slaughtered bovine hearts and in vivo using six anaesthetized closed-chest sheep.

In vitro experiments demonstrated that lesion size increased linearly with applied power up to 40 watts. When compared to radio frequency, laser energy penetrated more deeply into the myocardium. In the in vivo studies, using increasing powers of up to 40 watts for application times of 60 to 120 seconds created circular or elliptical lesions with surface dimensions up to 12 mm × 12 mm and depth of 9 mm (full LV wall thickness with a mean lesion diameter of 9.9 ± 5.2 mm and depth 5.8 ± 3.2 mm). Most lesions, 16 total in both right and left ventricular walls were transmural or near transmural in thickness. Lesions demonstrated coagulation necrosis with smooth well-demarcated borders. No animal suffered cardiac perforation, hypotension, hemopericardium, damage to cardiac valves, or cavitation effect from any of the ablations. Runs of VT were seen during energy application at the highest laser outputs in two animals.

In conclusion, this catheter design provides effective endocardial delivery of laser energy and is capable of creating transmural or nearly transmural lesions in vivo and in vitro, thereby potentially increasing the efficiency of VT ablation in CAD patients.

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References

  1. Blanchard SM, Walcott GP, Wharton JM, Ideker RE. Why is catheter ablation less successful than surgery for treating ventricular tachycardia that results from coronary artery disease? Pacing Clin Electrophysiol 1994;17:2315–2335.

    Google Scholar 

  2. Weber HP, Heinze A, Enders S, Ruprecht L, Unsold E. Laser versus radiofrequency catheter ablation of ventricular myocardium in dogs: A comparative test. Cardiology 1997;88(4):346–352.

    Google Scholar 

  3. Svenson RH, Littmann L, Gallagher JJ, Selle JG, Zimmern SH, Fedor JM, Colavita PG. Termination of ventricular tachycardia with epicardial laser photocoagulation: A clinical comparison with patients undergoing successful endocardial photocoagulation alone. J Am Coll Cardiol 1990;15:163–170.

    Google Scholar 

  4. Littmann L, Svenson RH, Gallagher JJ, Selle JG, Zimmern SH, Fedor JM, Colavita PG. Functional role of the epicardium in postinfarction ventricular tachycardia: Observations derived from computerized epicardial activation mapping, entrainment, and epicardial laser photoablation. Circulation 1991;83:1577–1591.

    Google Scholar 

  5. Selle JG, Svenson RH, Gallagher JJ, Littmann L, Sealy WC, Robicsek F. Surgical treatment of ventricular tachycardia with Nd:YAG laser photocoagulation. Pacing Clin Electrophysiol 1992;15:1352–1361.

    Google Scholar 

  6. DeBakker JMT, Coronel R, Tasseron S, Wilde AAM, Opthoff T, Janse MJ, van Capelle FJL, Becker AE, Jambroes G. Ventricular tachycardia in the infarcted, Langendorff-perfused human heart: Role of the arrangement of surviving cardiac fibers. J Am Coll Cardiol 1990;15:1594–1607.

    Google Scholar 

  7. Page PL, Cardinal R, Shenasa M, Kaltenbrunner W, Cossette R, Nadeau R. Surgical treatment of ventricular tachycardia: Regional cryoablation guided by computerized epicardial and endocardial mapping. Circulation 1989;80(Suppl. I):I-124–I-134.

    Google Scholar 

  8. Harken AH, Josephson ME, Horowitz LN. Surgical endocardial resection for the treatment of malignant ventricular tachycardia. Ann Surg 1979;190:456–460.

    Google Scholar 

  9. Guiraudon GM, Fontaine G, Frank R, Escande G, Etievent P, Cabrol C. Encircling endocardial ventriculotomy: A new surgical treatment of life-threatening ventricular tachycardias resistant to medical treatment following myocardial infarction. Ann Thorac Surg 1978;26:438–444.

    Google Scholar 

  10. Caceres J, Akhtar M, Werner P, Jazayeri M, McKinnie J, Avitall B, Tchou P. Cryoablation of refractory sustained ventricular tachycardia due to coronary artery disease.Am J Cardiol 1989;63:296–300.

    Google Scholar 

  11. Spielman SR, Michelson EL, Horowitz LN, Spear JF, Moore EN. The limitations of epicardial mapping as a guide to the surgical therapy of ventricular tachycardia. Circulation 1978;57:666–670.

    Google Scholar 

  12. Saksena S, Hussain SM, Gielchinsky I, Gielchinsky I, Gadhoke A, Pantopoulos D. Intraoperative mapping-guided argon laser ablation of malignant ventricular tachycardia. Am J Cardiol 1987;59:78–93.

    Google Scholar 

  13. Svenson RH, Selle JG, Gallagher JJ, Marroum MC, Tatsis GP, Seifert KT. Neodymium:YAG laser photocoagulation: A potentially useful method for intraoperative ablation of arrhythmogenic foci. In: Fontaine G, Scheinman MM, ed. Ablation in Cardiac Arrhythmias. Mt Kisco, NY: Futura Publishing, 1987:379–403.

    Google Scholar 

  14. Moosdorf R, Pfeiffer D, Schneider C, Jung W. Intraoperative laser photocoagulation of ventricular tachycardia. Am Heart J 1994;127:1133–1138.

    Google Scholar 

  15. 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 

  16. 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 

  17. Weber HP, Heinze A, Enders S. Catheter-directed laser coagulation of ventricular myocardium in dogs (abstract). Pacing Clin Electrophysiol 1994;17(4, Pt. II):832.

    Google Scholar 

  18. Curtis AB, Abela GS, Griffin JC, Hill JA, Normann SJ. Transvascular argon laser ablation of atrioventricular conduction in dogs: Feasibility and morphological results. Pacing Clin Electrophysiol 1989;12:347–357.

    Google Scholar 

  19. Curtis AB, Mansour M, Friedl SE, Tomaru T, Barbeau GR, Normann SJ, Abela GS. Modification of atrioventricular conduction using a combined laser-electrode catheter. Pacing Clin Electrophysiol 1994;17:337–348.

    Google Scholar 

  20. Nakagawa H, Yamanashi WS, Pitha JV, Arruda M, Wang X, Ohtomo K, Beckman KJ, McClelland JH, Lazzara R, Jackman WM. Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation. Circulation 1995;91:2264–2273.

    Google Scholar 

  21. Calkins H, Epstein A, Packer D, Arria AM, Hummel J, Gilligan DM, Trusso J, Carlson M, Luceri R, Kopelman H, Wilber D, Wharton JM, Stevenson W. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy. J Am Coll Cardiol 2000;35:1905–1914.

    Google Scholar 

  22. Kim YH, Sosa-Suarez G, Trouton TG, O'Nunain SS, Osswald S, McGovern BA, Ruskin JN, Garan H. Treatment of ventricular tachycardia by transcatheter radiofrequency ablation in patients with ischemic heart disease. Circulation 1994;89:1094–1102.

    Google Scholar 

  23. Morady F, Harvey M, Kalbfleisch SJ, el-Atassi R, Calkins H, Langberg JJ. Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease. Circulation 1993;87:363–372.

    Google Scholar 

  24. Stevenson WG, Khan H, Sager P, Saxon LA, Middlekauff HR, Natterson PD, Wiener I. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation 1993;88(4, Pt. I):1647–1670.

    Google Scholar 

  25. Littmann L, Svenson RH, Brucker G, Chuang C, Splinter R, Dezalin K, Tuntelder J, Thompson M, Tatsis GP. Comparative study on the efficacy and safety of transcatheter radiofrequency ablation and contact neodymium-YAGphotoablation of the left ventricular myocardium in dogs (abstract). Pacing Clin Electrophysiol 1993;16(4, Pt. II):859.

    Google Scholar 

  26. Obelienius V, Knepa A, Lubite Y. Histological studies of myocardium zones irradiated with Nd-YAG laser. Lasers Surg Med 1985;5:475–483.

    Google Scholar 

  27. Weber HP, Heinze A, Enders S, Ruprecht L, Unsold E. Catheter-directed laser coagulation of atrial myocardium in dogs. European Heart J 1994;15:971–980.

    Google Scholar 

  28. Hirao K, Yamamoto N, Ishihara N, Terai T, Motokawa K, Suzuki F, Hiejima K. Catheter ablation of canine ventricle using trans-balloon Nd:YAGlaser irradiation technique under direct supervision (abstract). Circulation 1994;90: I-486.

    Google Scholar 

  29. Oeff M. Laser, chemical, and cryothermal techniques as alternative methods for ablation. In: Podrid PJ, Kowey PR, eds. Cardiac Arrhythmia: Mechanisms, Diagnosis, and Management. Baltimore, MD: Williams and Wilkins, 1995:678–688.

    Google Scholar 

  30. Weber H, Enders S, Keiditisch E. Percutaneous Nd:YAG laser coagulation of ventricular myocardium in dogs using a special electrode laser catheter. Pacing Clin Electrophysiol 1989;12:899–910.

    Google Scholar 

  31. Ohtake H, Watanabe G, Misaki T, Matsunaga Y, Takahashi M, Tsunezuka Y, Kawasuji M, Watanabe Y. A new contact probes for intraoperative laser ablation. Pacing Clin Electrophysiol 1996;19:2060–2065.

    Google Scholar 

  32. Oeff M, Hug B, Muller G. Transcatheter laser photocoagulation for the treatment of cardiac arrhythmias. Lasers Med Sci 1991;6:355–361.

    Google Scholar 

  33. Vincent GM, Fox J, Knowlton K, Dixon JA. Catheterdirected Neodymium:YAG laser injury of the left ventricle for arrhythmia ablation: Dosimetry and hemodynamic, hematologic, and eletrophysiologic effects. Lasers Surg Med 1989;9:446–453.

    Google Scholar 

  34. Zheng SM, Kloner RA, Whittaker P. Ablation and coagulation of myocardial tissue by means of a pulsed holmium:YAG laser. Am Heart J 1993;26:1474–1477.

    Google Scholar 

  35. Ohtake H, Misaki T, Watanabe G, Mukai K, Matsunaga Y, Tsubota M, Kawasuji M, Watanabe Y. Myocardial coagulation by intraoperative Nd:YAG laser ablation and its dependence on blood perfusion. Pacing Clin Electrophysiol 1994;17:1627–1631.

    Google Scholar 

  36. Saksena S, Ciccone JM, Chandran P, Pantopoulos D, Lee B, Rothbart ST. Laser ablation of normal and diseased human ventricle. Am Heart J 1986;1132:52–60.

    Google Scholar 

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Authors and Affiliations

  1. University of Massachusetts, Worchester, MA, USA

    Alan Wagshall & S.K. Stephen Huang

  2. Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA

    George S. Abela & Alok Maheshwari

  3. Deaconess Hospital, Harvard Medical School, Boston, MA, USA

    George S. Abela

  4. Thoracic Cardiovascular Institute, Lansing, MI, USA

    Anoop Gupta

  5. CorMedica, Corp., Natick, MA, USA

    Russell Bowden

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  1. Alan Wagshall
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  2. George S. Abela
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  5. Russell Bowden
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  6. S.K. Stephen Huang
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Wagshall, A., Abela, G.S., Maheshwari, A. et al. A Novel Catheter Design for Laser Photocoagulation of the Myocardium to Ablate Ventricular Tachycardia. J Interv Card Electrophysiol 7, 13–22 (2002). https://doi.org/10.1023/A:1020859814224

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