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Journal of Interventional Cardiac Electrophysiology

Published in:

01-10-2018 | MULTIMEDIA REPORT

Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter

Authors: Ammar M. Killu, Niyada Naksuk, Faisal F. Syed, Christopher V. DeSimone, Prakriti Gaba, Chance Witt, Dorothy J. Ladewig, Scott H. Suddendorf, Joanne M. Powers, Gaurav Satam, Zdeněk Stárek, Tomas Kara, Jiří Wolf, Pavel Leinveber, Michal Crha, Miroslav Novák, Charles J. Bruce, Paul A. Friedman, Samuel J. Asirvatham

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2018

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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Title: Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter
Authors: Ammar M. Killu
Niyada Naksuk
Faisal F. Syed
Christopher V. DeSimone
Prakriti Gaba
Chance Witt
Dorothy J. Ladewig
Scott H. Suddendorf
Joanne M. Powers
Gaurav Satam
Zdeněk Stárek
Tomas Kara
Jiří Wolf
Pavel Leinveber
Michal Crha
Miroslav Novák
Charles J. Bruce
Paul A. Friedman
Samuel J. Asirvatham
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-018-0404-5

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Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter

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