Abstract
The impetus for the development of new treatment techniques, pharmacological or nonpharmacological, derives from an inner dissatisfaction with less than perfect results. This is a goal that we strive for, but that may never be achieved. Nevertheless, it is important to explore the possibilities inherent in new technologies in pursuit of this goal. The history of medicine is replete with numerous examples of new pharmacological agents supplanting existing ones, new technologies replacing the old, and new operative procedures expanding the horizon of potential cures for human disease. This chapter deals with the possibilities and limitations inherent in laser technology for the ablation of cardiac arrhythmias.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Durrer D, Buller J, Graaff P, Lo GI, et al. (1961). Epicadial excitation pattern as observed in the isolated revived and perfused fetal human heart. Circ Res 9: 29–38.
Durrer D, Formijne P, van Dam R Th, Buller J, et al. (1961). The electrocardiogram in normal and some abnormal conditions. Am Heart J 61: 303–314.
Durrer D, Van Lier AAW, Buller J (1964). Epicardial and intramural excitation in chronic myocardial infarction. Am Heart J 68: 765–776.
Cobb FR, Blumenschein SD, Sealy WC, Boineau JP, et al. (1968). Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 38: 1018–1029.
Spurrell RAJ, Yates AK, Thorburn CW, Sowton GE, et al. (1975). Surgical treatment of ventricular tachycardia after epicardial mapping studies. Br Heart J 37: 115–126.
Fontaine G, Guiraudon G, Frank R, Coutte R, et al. (1976). Epicardial mapping and surgical treatment in 6 cases of resistant ventricular tachycardia not related to coronary disease. In The Conduction System of the Heart. HJJ Wellens, KI Lie, MJ Janse, eds, Philadelphia: Lea and Febiger, pp 545–563.
Fontaine G, Guiraudon G, Frank R, Vedel J, et al. (1977). Stimulation studies and epicardial mapping in ventricular tachycardia: Study of mechanisms and selection for surgery. In Reentrant Arrhythmias, Mechanisms and Treatment, HE Kulbertus, ed. Baltimore: University Park Press, pp 334–350.
Guiraudon G, Fontaine G, Frank R, Leandri R, et al. (1981). Surgical treatment of ventricular tachycardia guided by ventricular mapping in 23 patients without coronary artery disease. Ann Thorac Surg 32: 439–450.
Gallagher JJ, Anderson RW, Kasell J, Rice JR, et al. (1978). Cryoablation of drug–resistant ventricular tachycardia in a patient with a variant of scleroderma. Circulation 57: 190–197.
Horowitz LN, Spear JF, Moore EN (1976). Subendocardial origin of ventricular arrhythmias in 24–hour–old experimental myocardial infarction. Circulation 53: 56–63.
Josephson ME, Horowitz LN, Farshidi A, Spear JF, et al. (1978). Recurrent sustained ventricular tachycardia. 2. Endocardial mapping. Circulation 57: 440–447.
Josephson ME, Harken AH, Horowitz LN (1979). Endocardial excision: A new surgical technique for the treatment of recurrent ventricular tachycardia. Circulation 60: 1430–1439.
Harken AH, Josephson ME, Horowitz LN (1979). Surgical endocardial resection for the treatment of malignant ventricular tachycardia. Ann Surg 190: 456–460.
Camm J, Ward DE, Cory-Pearce R, Rees GM, et al. (1979). The successful cryosurgical treatment of paroxysmal ventricular tachycardia. Chest 75: 621–624.
Klein GJ, Harrison L, Ideker RF, Smith WM, et al. (1979). Reaction of the myocardium to cryosurgery: Electrophysiology and arrhythmogenic potential. Circulation 59: 364–372.
KrafchekJ, LawrieGM, Wyndham CRC (1986). Cryoablation of arrhythmias from the interventricular septum: Initial experience with a new biventricular approach. J Thorac Cardiovasc Surg 91: 419–427.
Guiraudon G, Fontaine G, Frank R, Escande G, et al. (1978). Encircling endocardial ventriculotomy: A new surgical treatment for life–threatening ventricular tachycardias resistant to medical treatment following myocardial infarction. Ann Thorac Surg 26: 438–444.
Ostermeyer J, Breithardt G, Borggrefe M, Godehardt E, et al. (1984). Surgical treatment of ventricular tachycardias. Complete versus partial encircling endocardial ventriculotomy. J Thorac Cardiovasc Surg 87: 517–525.
Halldorsson T, Langerholc J (1978). Thermodynamic analysis of laser irradiation of biological tissue. Appl Optics 17: 3948–3958.
Langerholc J (1979). Moving phase transitions in laser–irradiated biological tissue. Appl Optics 18: 2286–2293.
Langerholc J (1982). Beam broadening in dense scattering media. Appl Optics 21: 1593–1598.
Pensei J, Hofstetter A, Frank F, Rothenberger K (1981). Temporal and spatial temperature profile of the bladder serosa in intravesical neodymium-YAG-laser irradiation. Eur Urol 7: 298–303.
Marchesini R, Andreola S, Emanuelli H, Melloni E, et al. (1985). Temperature rise in biological tissue during Nd.YAG laser irradiation. Lasers Surg Med 5: 75–82.
Svenson RH, Seile JG, Gallagher JJ, Marroum M-C, et al. (1987). Neodymium:YAG laser photocoagulation: A potentially useful method for intraoperative ablation of arrhythmogenic foci. In Ablation in Cardiac Arrhythmias, G Fontaine, M Scheinman, eds. Mount Kisco, NY: Futura Publishing Co., pp 379–403.
Svenson RH, Gallagher JJ, Seile JG, Zimmern SH, et al. (1987). Neodymium:YAG laser photocoagulation of ventricular tachycardia: Rationale, method of application, and results in 17 patients. In Nonpharmacological Therapy of Tachyarrhythmias, G Breithardt, M Borggrefe, DP Zipes, eds. Mount Kisco, NY: Futura Publishing Co., pp 181–199.
Welch AJ, Wissler EH, Priebe LA (1980). Significance of blood flow in calculations of temperature in laser irradiated tissue. Trans Biomed Eng BME 27: 164–166.
Svenson RH, Marroum MC, Frank F, Sella JG, et al. (1987). Successful Nd:YAG laser photocoagulation of arrhythmogenic myocardium: Potential limitations of current optical delivery systems. Proc SPIE 713: 74–81.
Svenson RH, Marroum MC, Bou-Saba G, Linder KD, et al. (1986). Subsurface vaporization (popcorn effect): A potential hazard of Nd:YAG laser radiation on myocardium. Proceedings of the International Symposium on Lasers in Cardiovascular Disease Baden/Vienna, Austria, June 26–28.
Svaasand LO, Boerslid T, Oeveraasen M (1985). Thermal and optical properties of living tissue: Application to laser–induced hyperthermia. Lasers Surg Med 5: 589–602.
Svenson RH, Gallagher JJ, Seile JG, Sealy WC, et al. (1986). Successful intraoperative Nd:YAG laser ablation of ventricular tachycardia. J Am Coll Cardiol 7: 237A.
Selle JG, Svenson RH, Sealy WC, Gallagher JJ, et al. (1986). Successful clinical laser ablation of ventricular tachycardia: A promising new therapeutic method. Ann Thorac Surg 42: 380–384.
Svenson RH, Gallagher JJ, Selle JG, Zimmern SH, et al. (1987). Neodymium:YAG laser photocoagulation: A successful new map–guided technique for the intraoperative ablation of ventricular tachycardia. Circulation 76:1319– 1328.
Gallagher JJ, Kasell JH, Cox JL, Smith WM, et al. (1982). Techniques of intraoperative electrophysiologic mapping. Am J Cardiol 49: 221–240.
Svenson RH, Gallagher JJ, Selle JG, Marroum M-C (1987). The role of the epicardium and intramural sites of ventricular tachycardia: Observations during neodymium:YAG photoablation of ventricular tachycardia in man. PACE 10: 428.
Miller JM, Kienzle MG, Harken AH, Josephson ME (1984). Subendocardial resection for ventricular tachycardia: Predictors of surgical success. Circulation 70: 624–631.
Garan H, Nguyen K, McGovern B, Buckley M, et al. (1986). Perioperative and long-term results after electrophysiologically directed ventricular surgery for recurrent ventricular tachycardia. J Am Coll Cardiol 8: 201–209.
Krafchek J, Lawrie GM, Roberts R, Magro SA, et al. (1986). Surgical ablation of ventricular tachycardia: Improved results with a map-directed regional approach. Circulation 73: 1239–1247.
Krön IL, Lerman B, DiMarco JP (1986). Surgical management of sustained ventricular arrhythmias presenting within eight weeks of acute myocardial infarction. Ann Thorac Surg 42: 13–16.
Borggrefe M, Podczeck A, Ostermeyer J, Breithardt G, et al. (1987). Long-term results of electrophysiologically guided antitachycardia surgery in ventricular tachyarrhythmias surgery: A collaborative report on 665 patients. In Non-pharmacological Therapy of Tachyarrhythmias, G Breithardt, M Borggrefe, DP Zipes, eds. Mount Kisco, NY: Futura Publishing Co., pp 109–132.
Svenson RH, Gallagher JJ, Zimmern SH, Fedor J, et al. (1987). Intraoperative Nd:YAG laser photocoagulative ablation of ventricular tachycardia: Observations relevant to transcatheter ablation techniques. J Am Coll Cardiol 9: 249A.
Guiraudon GM, Klein GJ, Jones DL, McLellan DG (1985). Encircling endocardial cryoablation for ventricular arrhythmias after myocardial infarction: Further experience. Circulation 72 (Suppl III): III–222.
Mikat EM, Hackel DB, Harrison L, Gallagher JJ, et al. (1977). Reaction of the myocardium and coronary arteries to cryosurgery. Lab Invest 37: 632–641.
Marroum MC, Svenson RH, Bou-Saba G, Linder KD, et al. (1986). Nd:YAG laser photocoagulation in canine myocardium, morphologic basis for application to ablation of arrhythmogenic foci in human myocardium. Proceedings of the International Symposium on Lasers in Cadiovascular Diseases. Baden/Vienna, Austria, June 26–28.
Mesnildrey P, Laborde F, Beloucif S, Mayolini P, et al. (1986). Tachycardies ventriculaires d’origine ischémique. Traitement chirurgical par thermo-exclusion circonférentielle au laser Nd-YAG. Presse Méd 15: 531–534.
Isner JM, Michlewitz H, Clarke RH, Estes NAM, et al. (1985). Laser photoablation of pathological endocardium: In vitro findings suggesting a new approach to the surgical treatment of refractory arrhythmias and restrictive cardiomyopathy. Ann Thorac Surg 39: 201–206.
Saksena S, CicconeJM, Chandran P, Pantopoulos D, et al. (1986). Laser ablation of normal and diseased human ventricle. Am Heart J 112: 52–60.
Saksena S, Hussain M, Gielchinsky I, Gadhoke A, et al. (1987). Intraoperative mapping-guided argon laser ablation of malignant ventricular tachycardia. Am J Cardiol 59: 78–83.
Isner JM, Donaldson RF, Deckelbaum LI, Clarke RH, et al. (1985). The excimer laser: Gross, light microscopic and ultrastructural analysis of potential advantages for use in laser therapy of cardiovascular disease. J Am Coll Cardiol 6: 1102–1109.
Downar E, Butany J, Jares A, Stoicheff BP (1986). Endocardial photoablation by excimer laser. J Am Coll Cardiol 7: 546–550.
Gallagher JJ, Selle JG, Svenson RH, Fedor JM, et al. (1988). Surgical treatment of arrhythmias. Am J Cardiol 6l: 27A–44A.
Bauernfeind RA, Amat-Y-Leon F, Dhingra RC, Kehoe R, et al. (1979). Chronic nonparoxysmal sinus tachycardia in otherwise healthy persons. Ann Intern Med 91: 702–710.
Yee R, Guiraudon GM, Gardner MJ, Gulamhusein SS, et al. (1984). Refractory paroxysmal sinus tachycardia: Management by subtotal right atrial exclusion. J Am Coll Cardiol 3: 400–404.
Boineau JP, Schuessler RB, Mooney CR, Wylds AC, et al. (1978). Multicentric origin of the atrial depolarization wave: The pacemaker complex. Circulation 58: 1036–1048.
Coumel P, Aigueperse J, Perrault MA (1973). Reperage et tentative d’exerese chirugicale d’un foyer ectopique auriculaire gauche avec tachycardie rebelle. Ann Cardiol Ang 2: 189–199.
Gallagher JJ, Cox JL, German LD, Kasell J (1984). Non-pharmacologic treatment of supraventricular tachycardia. In Tachycardias: Mechanisms, Diagnosis, Treatment, ME Josephson, HJJ Wellens, eds. Philadelphia: Lea and Febiger, pp 271–285.
Gillette PC, Wampler DG, Garson A, Zinner A, et al. (1985). Treatment of atrial automatic tachycardia by ablation procedures. J Am Coll Cardiol 6: 405–409.
Obelienius V, Bredikis J, Knepa A (1987). Myocardial isolation by Nd–YAG irradiation. In Ablation in Cardiac Arrhythmias, G Fontaine, MM Scheinman, eds. Mount Kisco, NY: Futura Publishing Co., pp 461–465.
Johnson DC, Nunn GR, Richards DA, Uther JB, et al. (1987). Surgical therapy for supraventricular tachycardia, a potentially curable disorder. J Thorac Cardiovasc Surg 93: 913–918.
Ross DL, Johnson DC, Denniss AR, Cooper MJ, et al. (1985). Curative surgery for atrioventricular junctional (“AV nodal”) reetrant tachycardia. J Am Coll Cardiol 6: 1383–1392.
Holman WL, Ikeshita M, Lease JG, Smith PK, et al. (1982). Elective prolongation of atrioventricular conduction by multiple discrete cryolesions: A new technique for the treatment of paroxysmal supraventricular tachycardia. J Thorac Cardiovasc Surg 84: 554–559.
Cox JL, Cain ME (1987). Discrete cryosurgical ablation of atrioventricular node reentry tachycardia in patients. J Am Coll Cardiol 9: 249A.
Guiraudon GM, Klein GJ, Sharma AD, Yee R (1987). Pathological insights gained by direct surgical approach to atrioventricular nodal reentrant tachycardias. Circulation 76 (Suppl IV): IV–500.
Narula OS, Boveja BK, Cohen DM, Narula JT, et al. (1985). Laser catheterinduced atrioventricular nodal delays and atrioventricular block in dogs: Acute and chronic observations. J Am Coll Cardiol 5: 259–267.
Gallagher JJ, Svenson RH, Kasell JH, German LD, et al. (1982). Catheter technique for closed-Chest ablation of the atrioventricular conduction system. A therapeutic alternative for the treatment of refractory supraventricular tachycardia. N Engl J Med 306: 194–200.
Narula OS, Bharati S, Chan MC, Embi AA, et al. (1984). Microtransection of the His bundle with laser radiation through a pervenous catheter: Correlation of histologic and electrophysiologic data. Am J Cardiol 54: 186–192.
Sargin ME, Portnoi VF, Skuba ND, Grigorov SS, et al. (1986). Experimental destruction of the atrioventricular junction of the conduction system of the heart by laser endoscopy. Byulleten ‘Eksperimental’ noi Biologii i Meditsiny 101: 504–507.
Bredikis J, Obelienius V, Knepa A, Sakalauskas J, et al. (1987). Comparative evaluation and perspectives of various techniques for ablation of conduction pathways in the heart. In Ablation in Cardiac Arrhythmias, G Fontaine, MM Scheinman, eds. Mount Kisco, NY: Futura Publishing Co., pp 479–488.
Obelienius V, Knepa A, Ambartzumian R, Markin E, et al. (1985). Transvenous ablation of the atrioventricular conduction system by laser irradiation under endoscopic control. Lasers Surg Med 5: 469–474.
Sealy WC, Wallace AJ, Ramming KP, Gallagher JJ, et al. (1974). An improved operation for the definitive treatment of the Wolff-Parkinson-White syndrome. Ann Thorac Surg 17: 107–113.
Guiraudon GM, Klein GJ, Sharma AD, Milstein S, et al. (1986). Closed-heart technique for Wolff-Parkinson-White syndrome: Further experience and potential limitations. Ann Thorac Surg 42: 651–657.
Saksena S, Hussain SM, Gielchinsky I, Pantopoulos D (1987). Intraoperative mapping-guided argon laser ablation of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Am J Cardiol 60: 196–199.
Fontaine G, Scheinman MM (eds) (1987). Ablation in Cardiac Arrhythmias. Mount Kisco, NY: Futura Publishing Co.
Breithardt G, Borggrefe M, Zipes DP (eds) (1987). Nonpharmacological Therapy of Tachyarrhythmias. Mount Kisco, NY: Futura Publishing Co.
Josephson ME, Horowitz LN, Spielman SR, Greenspan AM, et al. (1980). Comparison of endocardial catheter mapping with intraoperative mapping of ventricular tachycardia. Circulation 61: 395–404.
Hauer RNW, Heethaar RM, deZwart MTW, van Dijk RN, et al. (1986). Endocardial catheter mapping: Validation of a cineradiography method for accurate localization of left ventricular sites. Circulation 74: 862–868.
Downar E, Mickleborough L, Harris L., Parson I (1987). Intraoperative electrical ablation of ventricular arrhythmias: A “closed heart” procedure. J Am Coll Cardiol 10: 1048–1056.
Lee BI, Gottdiener JS, Fletcher RD, Rodriguez ER, et al. (1985). Transcatheter ablation: Comparison between laser photoablation and electrode shock ablation in the dog. Circulation 78. 71: 579–586.
Lee BI, Rodriguez ER, Notargiocomo A, Ferraris VJ, et al. (1986). Thermal effects of laser and electrical discharge on cardiovascular tissue: Implications for coronary artery recanalization and endocardial ablation. J Am Coll Cardiol 8: 193–200.
Vincent GM, Fox J, Benedick BA, Hunter J, et al. (1987). Laser catheter ablation of simulated ventricular tachycardia. Lasers Surg Med 7: 421–425.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1990 Kluwer Academic Publishers
About this chapter
Cite this chapter
Svenson, R.H. et al. (1990). Laser Modification of the Myocardium for the Treatment of Cardiac Arrhythmias: Background, Current Results, and Future Possibilities. In: Abela, G.S. (eds) Lasers in Cardiovascular Medicine and Surgery: Fundamentals and Techniques. Developments in Cardiovascular Medicine, vol 103. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1489-9_24
Download citation
DOI: https://doi.org/10.1007/978-1-4613-1489-9_24
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4612-8801-5
Online ISBN: 978-1-4613-1489-9
eBook Packages: Springer Book Archive