Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

Weber, H; Heinze, Armin; Enders, Susanne; Ruprecht, L.; Unsöld, E.

doi:10.1002/(sici)1096-9101(1998)22:2<109::aid-lsm7>3.0.co;2-t

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…While effective in the creation of deep lesions, these methods require precise penetration of the delivery source into the myocardial tissue and therefore run the risk of perforations with ensuing life threatening complications such as cardiac tamponade. More recently, Weber and colleagues [14,26] have developed a saline ushed noncontact laser system (EL system) that provides both an increased laser spot size for reducing power density …”

Section: Discussionsupporting

confidence: 90%

“…Most previous work used either a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser at 1064 nm or a diode laser operating at 805 nm [14,[22][23][24][25]. Weber and colleagues have demonstrated bene ts to using lasers over RF as well as methods for providing surface cooling during laser delivery [14,26]. The purpose of this study was to test the hypothesis that a new prototype cooled-tip laser catheter (CTLC) used with a low-power diode laser could create lesions with sizes and morphologies appropriate for treatment of VT.…”

Section: New Methodologiesmentioning

confidence: 99%

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Cooled-Tip Diode Laser Catheter for Improved Catheter Ablation of Ventricular Tachycardia

Snakard¹,

Miller

Berridge

et al. 2001

Journal of Investigative Surgery

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Catheter ablation for the treatment of arrhythmias has evolved dramatically over the past two decades. Researchers have investigated alternative energy sources and catheter constructs to improve the efficacy and safety of catheter ablation. This study tested the hypothesis that a new prototype cooled-tip laser catheter used with a low-power diode laser would improve catheter ablation of ventricular tachycardias. Four mongrel dogs underwent a median sternotomy. The cooled-tip laser catheter was advanced into the left ventricle via the left carotid artery and positioned adjacent to the endocardium. Laser powers of 3 and 4 W were delivered at four exposure times to select areas of the endocardium. During application of laser energy, room-temperature saline was circulated through the catheter. At necropsy the hearts were examined and fixed in formalin for histologic examination. Gross examination of the endocardial surfaces showed no indication of crater or thrombus formation. Cross-section of the lesions revealed sharply demarcated, circular-shaped areas of coagulative necrosis extending into the mid-myocardium. Areas of coagulative necrosis were identified within the myocardium extending into the mid-myocardium and occasionally the subepicardium. A sharp line of demarcation was observed between the lesions and the surrounding normal myocardium. The results of this study showed that we could use surface cooling during slow laser heating to create large subsurface lesions with characteristics appropriate for treatment of ventricular tachycardia and little to no surface damage. We believe our catheter system addresses many of the previous issues with laser-based approaches.

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Section: Discussionsupporting

confidence: 90%

Section: New Methodologiesmentioning

confidence: 99%

Cooled-Tip Diode Laser Catheter for Improved Catheter Ablation of Ventricular Tachycardia

Snakard¹,

Miller

Berridge

et al. 2001

Journal of Investigative Surgery

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show abstract

“…Lesion volume was similar in normal and in infracted myocardium. 39 An effective system for percutaneous ablation has not yet become clinically available.…”

Section: Irrigated Tip Catheter Ablationmentioning

confidence: 99%

Catheter Ablation of Ventricular Tachycardia in Patients with Coronary Heart Disease Part II: Clinical Aspects, Limitations, and Recent Developments

Delacrétaz

Stevenson

2001

Pacing Clinical Electrophis

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“…18 Thus, the laser method may help cope with difficulties encountered in some patients with deep intramural ventricular or subepicardial arrhythmia foci or with arrhythmogenic substrates shielded in scarred myocardium not amenable to catheter ablation by using radiofrequency current or cryoablation, but susceptible to the deeper penetrating laser light. [19][20][21] More recently, the assessment of electrical activity and lesion efficacy was reported by using electrogram amplitudes recorded via pin electrodes near the ablation tip of a RF catheter. 22 Endocardial voltage mapping technique was also used with a similar electrode arrangement to identified low-voltage right ventricular areas, which may represent the electroanatomical scar substrate of life-threatening tachyarrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Monitoring of Myocardial Lesion Formation during Laser Catheter Ablation in A Dog Model

Weber¹,

Sagerer-Gerhardt²

2014

J Innov Cardiac Rhythm Manage.

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Monitoring of lesion formation during catheter ablation is difficult to accomplish. To achieve that goal, monitoring of intracardiac local electrograms (LEGs) was performed during laser application by using an open-irrigated electrode laser mapping and ablation (ELMA) catheter provided with pin electrodes at its tip in a dog model. A total of 112 laser impacts were aimed at the atrial (15 W/5-30 s, n560) and at the ventricular free walls (20 W/20-50 s, n552) in 12 dogs. Amplitudes of potentials in the LEG gradually dwindled and were abolished in 8-13 s (9.9¡1.6) and in 25-32 s (28.1¡1.9) after radiation. Lesions achieved were correlated with the LEG recorded during formation of each lesion. After permanent abolishment of potentials, lesions were transmural. Radiation limited to 3-5 s allowed for complete recovery of potential amplitudes and did not produce lesions. In contrast to that, continuation of radiation .5 s beyond 13 s or 35 s, occasionally caused myocardial and collateral damages or malignant arrhythmias. A light-guide protection system (LPS) and transesophageal light sensor (TLS) helped avoid such damage. During laser application LEGs recorded via the pin electrodes mounted at the ELMA catheter tip allowed for monitoring of lesion formation.KEYWORDS. laser catheter ablation, monitoring of laser lesion formation, open-irrigated electrode laser mapping and ablation catheter, voltage of local intracardiac potential amplitudes.

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Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

Cited by 14 publications

References 22 publications

Cooled-Tip Diode Laser Catheter for Improved Catheter Ablation of Ventricular Tachycardia

Cooled-Tip Diode Laser Catheter for Improved Catheter Ablation of Ventricular Tachycardia

Catheter Ablation of Ventricular Tachycardia in Patients with Coronary Heart Disease Part II: Clinical Aspects, Limitations, and Recent Developments

Electrocardiographic Monitoring of Myocardial Lesion Formation during Laser Catheter Ablation in A Dog Model

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