Intrapulmonary vein ablation without stenosis: A novel balloon-based direct current electroporation approach

Chance M. Witt, Alan Sugrue, Deepak Padmanabhan, Vaibhav Vaidya, Sarah Gruba, James Rohl, Christopher V. DeSimone, Ammar M. Killu, Niyada Naksuk, Joanne Pederson, Scott Suddendorf, Dorothy J. Ladewig, Elad Maor, David R. Holmes, Suraj Kapa, Samuel J. Asirvatham

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background—Current thermal ablation methods for atrial fibrillation, including radiofrequency and cryoablation, have a suboptimal success rate. To avoid pulmonary vein (PV) stenosis, ablation is performed outside of the PV, despite the importance of triggers inside the vein. We previously reported on the acute effects of a novel direct current electroporation approach with a balloon catheter to create lesions inside the PVs in addition to the antrum. In this study, we aimed to determine whether the effects created by this nonthermal ablation method were associated with irreversible lesions and whether PV stenosis or other adverse effects occurred after a survival period. Methods and Results—Initial and survival studies were performed in 5 canines. At the initial study, the balloon catheter was inflated to contact the antrum and interior of the PV. Direct current energy was delivered between 2 electrodes on the catheter in ECG-gated 100 μs pulses. A total of 10 PVs were treated demonstrating significant acute local electrogram diminution (mean amplitude decrease of 61.2±19.8%). After the survival period (mean 27 days), computed tomography imaging showed no PV stenosis. On histologic evaluation, transmural, although not circumferential, lesions were seen in each treated vein. No PV stenosis or esophageal injury was present. Conclusions—Irreversible, transmural lesions can be created inside the PV without evidence of stenosis after a 27-day survival period using this balloon-based direct current ablation approach. These early data show promise for an ablation approach that could directly treat PV triggers in addition to traditional PV antrum ablation.

Original languageEnglish (US)
Article numbere009575
JournalJournal of the American Heart Association
Volume7
Issue number14
DOIs
StatePublished - Jul 1 2018

Keywords

  • Animal study
  • Atrial fibrillation
  • Direct current ablation
  • Electroporation
  • Pulmonary vein stenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Witt, C. M., Sugrue, A., Padmanabhan, D., Vaidya, V., Gruba, S., Rohl, J., DeSimone, C. V., Killu, A. M., Naksuk, N., Pederson, J., Suddendorf, S., Ladewig, D. J., Maor, E., Holmes, D. R., Kapa, S., & Asirvatham, S. J. (2018). Intrapulmonary vein ablation without stenosis: A novel balloon-based direct current electroporation approach. Journal of the American Heart Association, 7(14), [e009575]. https://doi.org/10.1161/JAHA.118.009575