External Arrhythmia Ablation Using Photon Beams

H. Immo Lehmann, Amanda J. Deisher, Mitsuru Takami, Jon J. Kruse, Limin Song, Sarah E. Anderson, Jack T. Cusma, Kay D. Parker, Susan B. Johnson, Samuel J Asirvatham, Robert C. Miller, Michael G. Herman, Douglas L Packer

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background - This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs. Methods and Results - Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86%). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume. Conclusions - Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.

Original languageEnglish (US)
Article numbere004304
JournalCirculation: Arrhythmia and Electrophysiology
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Photons
Cardiac Arrhythmias
Coronary Vessels
Swine
Phrenic Nerve
Catheter Ablation
Atrioventricular Block
Trachea
Esophagus
Histology
Radiotherapy
Radiation

Keywords

  • atrioventricular node
  • catheter ablation
  • photons
  • tachycardia, ventricular
  • x-ray

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lehmann, H. I., Deisher, A. J., Takami, M., Kruse, J. J., Song, L., Anderson, S. E., ... Packer, D. L. (2017). External Arrhythmia Ablation Using Photon Beams. Circulation: Arrhythmia and Electrophysiology, 10(4), [e004304]. https://doi.org/10.1161/CIRCEP.116.004304

External Arrhythmia Ablation Using Photon Beams. / Lehmann, H. Immo; Deisher, Amanda J.; Takami, Mitsuru; Kruse, Jon J.; Song, Limin; Anderson, Sarah E.; Cusma, Jack T.; Parker, Kay D.; Johnson, Susan B.; Asirvatham, Samuel J; Miller, Robert C.; Herman, Michael G.; Packer, Douglas L.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 10, No. 4, e004304, 01.04.2017.

Research output: Contribution to journalArticle

Lehmann, HI, Deisher, AJ, Takami, M, Kruse, JJ, Song, L, Anderson, SE, Cusma, JT, Parker, KD, Johnson, SB, Asirvatham, SJ, Miller, RC, Herman, MG & Packer, DL 2017, 'External Arrhythmia Ablation Using Photon Beams', Circulation: Arrhythmia and Electrophysiology, vol. 10, no. 4, e004304. https://doi.org/10.1161/CIRCEP.116.004304
Lehmann HI, Deisher AJ, Takami M, Kruse JJ, Song L, Anderson SE et al. External Arrhythmia Ablation Using Photon Beams. Circulation: Arrhythmia and Electrophysiology. 2017 Apr 1;10(4). e004304. https://doi.org/10.1161/CIRCEP.116.004304
Lehmann, H. Immo ; Deisher, Amanda J. ; Takami, Mitsuru ; Kruse, Jon J. ; Song, Limin ; Anderson, Sarah E. ; Cusma, Jack T. ; Parker, Kay D. ; Johnson, Susan B. ; Asirvatham, Samuel J ; Miller, Robert C. ; Herman, Michael G. ; Packer, Douglas L. / External Arrhythmia Ablation Using Photon Beams. In: Circulation: Arrhythmia and Electrophysiology. 2017 ; Vol. 10, No. 4.
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abstract = "Background - This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs. Methods and Results - Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86{\%}). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume. Conclusions - Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.",
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AU - Song, Limin

AU - Anderson, Sarah E.

AU - Cusma, Jack T.

AU - Parker, Kay D.

AU - Johnson, Susan B.

AU - Asirvatham, Samuel J

AU - Miller, Robert C.

AU - Herman, Michael G.

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N2 - Background - This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs. Methods and Results - Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86%). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume. Conclusions - Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.

AB - Background - This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs. Methods and Results - Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86%). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume. Conclusions - Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.

KW - atrioventricular node

KW - catheter ablation

KW - photons

KW - tachycardia, ventricular

KW - x-ray

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