Laser versus Radiofrequency Catheter Ablation of Ventricular Myocardium in Dogs: A Comparative Test

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

doi:10.1159/000177358

Cited by 27 publications

(17 citation statements)

References 22 publications

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“…Transmural lesions can be produced through normal and scarred myocardium without compromising the anatomic integrity of the ventricular walls. Recently, we have demonstrated that Nd:YAG laser catheter irradiation of canine myocardium produces deeper lesions, in a more controllable manner and with less endocardial damage than radiofrequency current application (24). Based on these promising experimental results and our successful clinical experience with laser ablation of supraventricular arrhythmias, we have recently extended the laser technique on candidates for ablation of VT including patients with diseased myocardium.…”

Section: Discussionmentioning

confidence: 99%

Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

et al. 1998

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Section: Discussionmentioning

confidence: 99%

Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

et al. 1998

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“…Nonetheless, depth of lesions achieved in these circumstances measured up to 4.0 mm is still sufficient for producing transmural coagulation in the thin-walled atria. In our experience, in vivo laser lesions are substantially larger as compared to those achieved during in vitro experiments, and are also larger than RF lesions when similar levels of energy are applied [14].…”

Section: Discussionmentioning

confidence: 59%

Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter

Sagerer-Gerhardt

Weber²

2016

Lasers Med Sci

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Lesion sizes and quality are crucial for successful catheter ablation procedures. We sought to test the influence of catheter orientation towards the endocardial surface on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter. Continuous wave 1064-nm laser catheter applications at 15 W (4.5 W/mm²)/30 s, (135 J/mm²), irrigation flow 30 mL/min, were aimed at the left ventricular endocardial surface of bovine myocardium. The catheter was kept in vertical, in slanting (67.5°, 45°, 22.5°), and in flat positions; in flat position, also 60 s of radiation times were applied (n = 10, each). Lesions were evaluated morphometrically. Maximum depth of lesion was achieved with the catheter in a vertical orientation. Catheter inclination of <22.5 showed a highly significant decrease of lesion depth from 5.6 ± 1.1 to 3.7 ± 0.5 mm (p = 0.0001). In a flat catheter position, laser radiation of 30 s achieved the smallest lesions. However, after 60 s of radiation, the flat lesions were similar in depth (p = 087) and were larger in width (p = 0.0004) and in volumes (p = 0.0025) as compared to the lesions achieved with the catheter in vertical position after 30 s of radiation. Steam-pop with intramural cavitation or tissue vaporization with crater formation did not occur. Longer radiation times can achieve larger lesions regardless of catheter orientation. Catheter orientation is not a major determinant for laser ablation lesion size and quality, and a steerable support may not be needed when using the open-irrigated electrode-laser mapping and ablation (ELMA) catheter RytmoLas.

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“…Although RF has proven 90-95% successful in the treatment of supraventricular tachyarrhythmias, it fails to destroy the arrhythmogenic cardiac tissue in 30 to 50% of the patients with VT secondary to myocardial infarction [8][9][10][11][12][13]. A crucial limitation of RFCA is its inability to ablate tissue in the mid-myocardial and subepicardial regions where VT foci often originate [11,[14][15][16]. Surface charring of the endocardium and coagulum formation on the electrode surface often occur when creation of larger, deeper lesions is attempted [14,17].…”

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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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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Laser versus Radiofrequency Catheter Ablation of Ventricular Myocardium in Dogs: A Comparative Test

Cited by 27 publications

References 22 publications

Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

Laser catheter coagulation of normal and scarred ventricular myocardium in dogs

Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter

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

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