Atrioventricular node ablation in langendorff-perfused porcine hearts using carbon ion particle therapy

H. Immo Lehmann, Daniel Richter, Hannah Prokesch, Christian Graeff, Matthias Prall, Palma Simoniello, Claudia Fournier, Julia Bauer, Robert Kaderka, Alexander Weymann, Gabor Szabo, Karin Sonnenberg, Anna M. Constantinescu, Susan B. Johnson, Juna Misiri, Mitsuru Takami, Robert C. Miller, Michael G. Herman, Samuel J. Asirvatham, Stephan BronsOliver Jäkel, Thomas Haberer, Jürgen Debus, Marco Durante, Christoph Bert, Douglas L. Packer

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Particle therapy, with heavy ions such as carbon-12 (12 C), delivered to arrhythmogenic locations of the heart could be a promising new means for catheter-free ablation. As a first investigation, we tested the feasibility of in vivo atrioventricular node ablation, in Langendorff-perfused porcine hearts, using a scanned 12C beam. Methods and Results-Intact hearts were explanted from 4 (30-40 kg) pigs and were perfused in a Langendorff organ bath. Computed tomgraphic scans (1 mm voxel and slice spacing) were acquired and 12 C ion beam treatment planning (optimal accelerator energies, beam positions, and particle numbers) for atrioventricular node ablation was conducted. Orthogonal X-rays with matching of 4 implanted clips were used for positioning. Ten Gray treatment plans were repeatedly administered, using pencil beam scanning. After delivery, positron emission tomography-computed tomgraphic scans for detection of β + (11 C) activity were obtained. A 12 C beam with a full width at half maximum of 10 mm was delivered to the atrioventricular node. Delivery of 130 Gy caused disturbance of atrioventricular conduction with transition into complete heart block after 160 Gy. Positron emission computed tomgraphy demonstrated dose delivery into the intended area. Application did not induce arrhythmias. Macroscopic inspection did not reveal damage to myocardium. Immunostaining revealed strong γH2AX signals in the target region, whereas no γH2AX signals were detected in the unirradiated control heart. Conclusions-This is the first report of the application of a 12 C beam for ablation of cardiac tissue to treat arrhythmias. Catheter-free ablation using 12C beams is feasible and merits exploration in intact animal studies as an energy source for arrhythmia elimination.

Original languageEnglish (US)
Pages (from-to)429-438
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number2
DOIs
StatePublished - Apr 20 2015

Keywords

  • Atrial fibrillation
  • atrioventricular node
  • carbon particle therapy
  • catheter-free ablation
  • tachycardia, ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Lehmann, H. I., Richter, D., Prokesch, H., Graeff, C., Prall, M., Simoniello, P., Fournier, C., Bauer, J., Kaderka, R., Weymann, A., Szabo, G., Sonnenberg, K., Constantinescu, A. M., Johnson, S. B., Misiri, J., Takami, M., Miller, R. C., Herman, M. G., Asirvatham, S. J., ... Packer, D. L. (2015). Atrioventricular node ablation in langendorff-perfused porcine hearts using carbon ion particle therapy. Circulation: Arrhythmia and Electrophysiology, 8(2), 429-438. https://doi.org/10.1161/CIRCEP.114.002436