Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation

Results of an Efficacy and Safety Study

Malini Madhavan, K. L. Venkatachalam, Matthew J. Swale, Christopher V. Desimone, Joseph J. Gard, Susan B. Johnson, Scott H. Suddendorf, Susan B. Mikell, Dorothy J. Ladewig, Toni Grabinger Nosbush, Andrew J. Danielsen, Mark Knudson, Samuel J Asirvatham

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. Methods: Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. Results: Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. Conclusion: Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Atrial Fibrillation
Canidae
Dogs
Safety
Catheters
Alcohols
Transverse Sinuses
Cardiac Electrophysiologic Techniques
Electroporation
Pulmonary Veins
Ventricular Fibrillation
Heart Atria
Cardiac Arrhythmias
Veins
Myocardium
Thorax
Heart Rate
Blood Pressure
Injections
Wounds and Injuries

Keywords

  • Ablation
  • Alcohol
  • Atrial fibrillation
  • Autonomic innervation
  • Canine
  • Direct current
  • Epicardial
  • Ganglionated plexus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation : Results of an Efficacy and Safety Study. / Madhavan, Malini; Venkatachalam, K. L.; Swale, Matthew J.; Desimone, Christopher V.; Gard, Joseph J.; Johnson, Susan B.; Suddendorf, Scott H.; Mikell, Susan B.; Ladewig, Dorothy J.; Nosbush, Toni Grabinger; Danielsen, Andrew J.; Knudson, Mark; Asirvatham, Samuel J.

In: PACE - Pacing and Clinical Electrophysiology, 2016.

Research output: Contribution to journalArticle

Madhavan, M, Venkatachalam, KL, Swale, MJ, Desimone, CV, Gard, JJ, Johnson, SB, Suddendorf, SH, Mikell, SB, Ladewig, DJ, Nosbush, TG, Danielsen, AJ, Knudson, M & Asirvatham, SJ 2016, 'Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study', PACE - Pacing and Clinical Electrophysiology. https://doi.org/10.1111/pace.12824
Madhavan, Malini ; Venkatachalam, K. L. ; Swale, Matthew J. ; Desimone, Christopher V. ; Gard, Joseph J. ; Johnson, Susan B. ; Suddendorf, Scott H. ; Mikell, Susan B. ; Ladewig, Dorothy J. ; Nosbush, Toni Grabinger ; Danielsen, Andrew J. ; Knudson, Mark ; Asirvatham, Samuel J. / Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation : Results of an Efficacy and Safety Study. In: PACE - Pacing and Clinical Electrophysiology. 2016.
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abstract = "Background: Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. Methods: Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. Results: Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. Conclusion: Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.",
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author = "Malini Madhavan and Venkatachalam, {K. L.} and Swale, {Matthew J.} and Desimone, {Christopher V.} and Gard, {Joseph J.} and Johnson, {Susan B.} and Suddendorf, {Scott H.} and Mikell, {Susan B.} and Ladewig, {Dorothy J.} and Nosbush, {Toni Grabinger} and Danielsen, {Andrew J.} and Mark Knudson and Asirvatham, {Samuel J}",
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T2 - Results of an Efficacy and Safety Study

AU - Madhavan, Malini

AU - Venkatachalam, K. L.

AU - Swale, Matthew J.

AU - Desimone, Christopher V.

AU - Gard, Joseph J.

AU - Johnson, Susan B.

AU - Suddendorf, Scott H.

AU - Mikell, Susan B.

AU - Ladewig, Dorothy J.

AU - Nosbush, Toni Grabinger

AU - Danielsen, Andrew J.

AU - Knudson, Mark

AU - Asirvatham, Samuel J

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N2 - Background: Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. Methods: Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. Results: Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. Conclusion: Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.

AB - Background: Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. Methods: Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. Results: Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. Conclusion: Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.

KW - Ablation

KW - Alcohol

KW - Atrial fibrillation

KW - Autonomic innervation

KW - Canine

KW - Direct current

KW - Epicardial

KW - Ganglionated plexus

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