Electroporation of epicardial autonomic ganglia: Safety and efficacy in medium-term canine models

Deepak Padmanabhan, Niyada Naksuk, Ammar K. Killu, Suraj Kapa, Chance Witt, Alan Sugrue, Christopher V. Desimon, Malini Madhavan, J. R. de Groot, Barry O'Brien, Tadhg Rabbette, Kenneth Coffey, Samuel J. Asirvatham

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Endocardial radiofrequency ablation of epicardial ganglionic plexus (GP) for atrial fibrillation (AF) is complicated by myocardial damage. Objectives: We hypothesized that an epicardial approach with a novel nitinol catheter system capable of causing irreversible electroporation (IRE) with direct current (DC) could selectively and permanently destroy GP without collateral myocardial injury. Methods: Acute studies and medium-term terminal studies (mean survival, 1137 days) were performed with seven dogs. In the acute studies, DC was used to target epicardial GP within the transverse sinus, oblique sinus, vein of Marshall, and right periaortic space. Successful electroporation was defined as the presence of ablative lesions in the GP without collateral myocardial damage. A four-point integer system was used to classify histologic changes in tissue harvested from the ablation sites. Atrial effective refractory period (AERP) was measured during the acute and medium-term studies. Results: For six dogs in the medium-term studies, the postablation period was uneventful without complications. Lesions were successfully created at 20 of 21 sites (95.2%) with more than minimal myocardial damage in one dog. An increase in AERP occurred in both atria during the acute studies but was maintained only in the right atrium at medium-term follow-up (5032 milliseconds). No dog had damage to the esophagus, adjacent great arteries, or pulmonary veins. Conclusions: This proof-of-concept study suggests that safe, effective, and selective epicardial ablation of GP can be performed with DC by IRE with minimal collateral myocardial damage.

Original languageEnglish (US)
Pages (from-to)607-615
Number of pages9
JournalJournal of cardiovascular electrophysiology
Volume30
Issue number4
DOIs
StatePublished - Apr 2019

Keywords

  • atrial fibrillation
  • cardiac ganglionic plexus
  • direct current ablation
  • irreversible electroporation
  • novel ablation catheters

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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