Epicardial Catheter Ablation Using High-Intensity Ultrasound: Validation in a Swine Model

Babak Nazer, Vasant Salgaonkar, Chris J. Diederich, Peter D. Jones, Srikant Duggirala, Yasuaki Tanaka, Bennett Ng, Richard Sievers, Edward P. Gerstenfeld

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Epicardial radiofrequency catheter ablation of ventricular tachycardia remains challenging because of the presence of deep myocardial scar and adjacent cardiac structures, such as the coronary arteries, phrenic nerve, and epicardial fat that limit delivery of radiofrequency energy. High-intensity ultrasound (HIU) is an acoustic energy source able to deliver deep lesions through fat, while sparing superficial structures. We developed and tested an epicardial HIU ablation catheter in a closed chest, in vivo swine model. Methods and Results-The HIU catheter is an internally cooled, 14-French, side-facing catheter, integrated with A-mode ultrasound guidance. Swine underwent percutaneous subxyphoid epicardial access and ablation with HIU (n=10 swine) at 15, 20, and 30 W. Compared with irrigated radiofrequency lesions in control swine (n = 5), HIU demonstrated increased lesion depth (HIU 11.6±3.2 mm versus radiofrequency 4.7±1.6 mm; mean±SD) and epicardial sparing (HIU 2.9±2.1 mm versus radiofrequency 0.1±0.2 mm) at all HIU powers, and increased lesion volume at HIU 20 and 30 W (P<0.0001 for all comparisons). HIU ablation over coronary arteries and surrounding epicardial fat resulted in deep lesions with normal angiographic flow. Histological disruption of coronary adventitia, but not media or intima, was noted in 44% of lesions. Conclusions-Compared with radiofrequency, HIU ablation in vivo demonstrates significantly deeper and larger lesions with greater epicardial sparing in a dose-dependent manner. Further development of this catheter may lead to a promising alternative to epicardial radiofrequency ablation.

Original languageEnglish (US)
Pages (from-to)1491-1497
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Catheter Ablation
Swine
Catheters
Fats
Coronary Vessels
Adventitia
Phrenic Nerve
Ventricular Tachycardia
Acoustics
Cicatrix
Thorax

Keywords

  • Catheter ablation
  • epicardium
  • phrenic nerve
  • swine
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Nazer, B., Salgaonkar, V., Diederich, C. J., Jones, P. D., Duggirala, S., Tanaka, Y., ... Gerstenfeld, E. P. (2015). Epicardial Catheter Ablation Using High-Intensity Ultrasound: Validation in a Swine Model. Circulation: Arrhythmia and Electrophysiology, 8(6), 1491-1497. https://doi.org/10.1161/CIRCEP.115.003547

Epicardial Catheter Ablation Using High-Intensity Ultrasound : Validation in a Swine Model. / Nazer, Babak; Salgaonkar, Vasant; Diederich, Chris J.; Jones, Peter D.; Duggirala, Srikant; Tanaka, Yasuaki; Ng, Bennett; Sievers, Richard; Gerstenfeld, Edward P.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 6, 01.12.2015, p. 1491-1497.

Research output: Contribution to journalArticle

Nazer, B, Salgaonkar, V, Diederich, CJ, Jones, PD, Duggirala, S, Tanaka, Y, Ng, B, Sievers, R & Gerstenfeld, EP 2015, 'Epicardial Catheter Ablation Using High-Intensity Ultrasound: Validation in a Swine Model', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 6, pp. 1491-1497. https://doi.org/10.1161/CIRCEP.115.003547
Nazer, Babak ; Salgaonkar, Vasant ; Diederich, Chris J. ; Jones, Peter D. ; Duggirala, Srikant ; Tanaka, Yasuaki ; Ng, Bennett ; Sievers, Richard ; Gerstenfeld, Edward P. / Epicardial Catheter Ablation Using High-Intensity Ultrasound : Validation in a Swine Model. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 6. pp. 1491-1497.
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AU - Nazer, Babak

AU - Salgaonkar, Vasant

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AU - Jones, Peter D.

AU - Duggirala, Srikant

AU - Tanaka, Yasuaki

AU - Ng, Bennett

AU - Sievers, Richard

AU - Gerstenfeld, Edward P.

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N2 - Epicardial radiofrequency catheter ablation of ventricular tachycardia remains challenging because of the presence of deep myocardial scar and adjacent cardiac structures, such as the coronary arteries, phrenic nerve, and epicardial fat that limit delivery of radiofrequency energy. High-intensity ultrasound (HIU) is an acoustic energy source able to deliver deep lesions through fat, while sparing superficial structures. We developed and tested an epicardial HIU ablation catheter in a closed chest, in vivo swine model. Methods and Results-The HIU catheter is an internally cooled, 14-French, side-facing catheter, integrated with A-mode ultrasound guidance. Swine underwent percutaneous subxyphoid epicardial access and ablation with HIU (n=10 swine) at 15, 20, and 30 W. Compared with irrigated radiofrequency lesions in control swine (n = 5), HIU demonstrated increased lesion depth (HIU 11.6±3.2 mm versus radiofrequency 4.7±1.6 mm; mean±SD) and epicardial sparing (HIU 2.9±2.1 mm versus radiofrequency 0.1±0.2 mm) at all HIU powers, and increased lesion volume at HIU 20 and 30 W (P<0.0001 for all comparisons). HIU ablation over coronary arteries and surrounding epicardial fat resulted in deep lesions with normal angiographic flow. Histological disruption of coronary adventitia, but not media or intima, was noted in 44% of lesions. Conclusions-Compared with radiofrequency, HIU ablation in vivo demonstrates significantly deeper and larger lesions with greater epicardial sparing in a dose-dependent manner. Further development of this catheter may lead to a promising alternative to epicardial radiofrequency ablation.

AB - Epicardial radiofrequency catheter ablation of ventricular tachycardia remains challenging because of the presence of deep myocardial scar and adjacent cardiac structures, such as the coronary arteries, phrenic nerve, and epicardial fat that limit delivery of radiofrequency energy. High-intensity ultrasound (HIU) is an acoustic energy source able to deliver deep lesions through fat, while sparing superficial structures. We developed and tested an epicardial HIU ablation catheter in a closed chest, in vivo swine model. Methods and Results-The HIU catheter is an internally cooled, 14-French, side-facing catheter, integrated with A-mode ultrasound guidance. Swine underwent percutaneous subxyphoid epicardial access and ablation with HIU (n=10 swine) at 15, 20, and 30 W. Compared with irrigated radiofrequency lesions in control swine (n = 5), HIU demonstrated increased lesion depth (HIU 11.6±3.2 mm versus radiofrequency 4.7±1.6 mm; mean±SD) and epicardial sparing (HIU 2.9±2.1 mm versus radiofrequency 0.1±0.2 mm) at all HIU powers, and increased lesion volume at HIU 20 and 30 W (P<0.0001 for all comparisons). HIU ablation over coronary arteries and surrounding epicardial fat resulted in deep lesions with normal angiographic flow. Histological disruption of coronary adventitia, but not media or intima, was noted in 44% of lesions. Conclusions-Compared with radiofrequency, HIU ablation in vivo demonstrates significantly deeper and larger lesions with greater epicardial sparing in a dose-dependent manner. Further development of this catheter may lead to a promising alternative to epicardial radiofrequency ablation.

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KW - epicardium

KW - phrenic nerve

KW - swine

KW - ventricular tachycardia

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