Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter

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 Andrew Friedman, Samuel J Asirvatham

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jul 14 2018

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Phrenic Nerve
Catheters
Coronary Vessels
Swine
Ventricular Fibrillation
Ventricular Tachycardia
Canidae
Cardiac Arrhythmias
Electrodes
Wounds and Injuries
Therapeutics

Keywords

  • Ablation
  • Epicardial
  • Insulation
  • Pericardial
  • Phrenic nerve
  • Scar

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter. / Killu, Ammar M.; Naksuk, Niyada; Syed, Faisal F.; DeSimone, Christopher V.; Gaba, Prakriti; Witt, Chance; Ladewig, Dorothy J.; Suddendorf, Scott H.; Powers, Joanne M.; Satam, Gaurav; Stárek, Zdeněk; Kara, Tomas; Wolf, Jiří; Leinveber, Pavel; Crha, Michal; Novák, Miroslav; Bruce, Charles J; Friedman, Paul Andrew; Asirvatham, Samuel J.

In: Journal of Interventional Cardiac Electrophysiology, 14.07.2018, p. 1-9.

Research output: Contribution to journalArticle

Killu, AM, Naksuk, N, Syed, FF, DeSimone, CV, Gaba, P, Witt, C, Ladewig, DJ, Suddendorf, SH, Powers, JM, Satam, G, Stárek, Z, Kara, T, Wolf, J, Leinveber, P, Crha, M, Novák, M, Bruce, CJ, Friedman, PA & Asirvatham, SJ 2018, 'Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter', Journal of Interventional Cardiac Electrophysiology, pp. 1-9. https://doi.org/10.1007/s10840-018-0404-5
Killu, Ammar M. ; Naksuk, Niyada ; Syed, Faisal F. ; DeSimone, Christopher V. ; Gaba, Prakriti ; Witt, Chance ; Ladewig, Dorothy J. ; Suddendorf, Scott H. ; Powers, Joanne M. ; Satam, Gaurav ; Stárek, Zdeněk ; Kara, Tomas ; Wolf, Jiří ; Leinveber, Pavel ; Crha, Michal ; Novák, Miroslav ; Bruce, Charles J ; Friedman, Paul Andrew ; Asirvatham, Samuel J. / Feasibility of directional percutaneous epicardial ablation with a partially insulated catheter. In: Journal of Interventional Cardiac Electrophysiology. 2018 ; pp. 1-9.
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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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AU - Killu, Ammar M.

AU - Naksuk, Niyada

AU - Syed, Faisal F.

AU - DeSimone, Christopher V.

AU - Gaba, Prakriti

AU - Witt, Chance

AU - Ladewig, Dorothy J.

AU - Suddendorf, Scott H.

AU - Powers, Joanne M.

AU - Satam, Gaurav

AU - Stárek, Zdeněk

AU - Kara, Tomas

AU - Wolf, Jiří

AU - Leinveber, Pavel

AU - Crha, Michal

AU - Novák, Miroslav

AU - Bruce, Charles J

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

PY - 2018/7/14

Y1 - 2018/7/14

N2 - 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.

AB - 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.

KW - Ablation

KW - Epicardial

KW - Insulation

KW - Pericardial

KW - Phrenic nerve

KW - Scar

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