Modification of A-V conduction using a percutaneous combined laser-electrode catheter

Mansour, Michael; Curtis, Anne B.; Abela, George S.; Barbeau, Gérald; Friedl, Stephan E.; Kunz, W; Caravello, John W.; Lombard, Christophe W.

doi:10.1016/0735-1097(90)92126-m

Cited by 2 publications

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“…With improvement in the guiding technology involving some steerability at the tip of the electrode catbeter, an even more precise delivery of laser energy might be an-PACE, Vol. 16 March, Part I 1993 ticipated with more predictable areas of damage, and a 100% success rate. It is intriguing to speculate whether Nd:YAG laser photocoagulation from the aortic root might become a clinically useful tool of catheter ablation of AV conduction.…”

Section: Discussionmentioning

confidence: 99%

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Catheterization Technique for Laser Photoahlation of Atrioventricular Conduction from the Aortic Root in Dogs

Littmann¹,

Svenson²,

Chuang³

et al. 1993

Pacing Clinical Electrophis

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A simple catheterization technique for producing suppression or block of atrioventricular (AV) conduction in dogs by neodymium:YAG (Nd:YAG) laser photocoagulation from the aortic root is described. In 14 canines, electrode catheters were percutaneously advanced to the high right atrium, to the His bundle area at the tricuspid valve (right His [RH]), and the noncoronary cusp of the aortic valve (left His [LH]). A 400 microns optical fiber was fed into the lumen of the LH catheter. Continuous wave Nd:YAG lasing at lambda = 1,064 nm at 15-20 watts was performed at the site of the largest recorded LH deflection, opposite to the RH catheter, until complete AV block (CAVB, group I, eight dogs) or persistent A-H prolongation (AHPr, group II, four dogs) occurred; in two animals, laser photoablation was unsuccessful. CAVB and AHPr were achieved in < 140 seconds of lasing. Mean lasing time was 51 +/- 41 seconds, total energy delivered, 776 +/- 601 J. There were no complications. Dogs were followed for up to 120 days. In group I, 6/6 dogs followed for at least 1 week continued to have CAVB (three AV nodal, five infra-His). In group II, 1/4 dog progressed to infra-His CAVB; 3/4 had depressed AV nodal function. AV block was not reversed by isoproterenol. Aortic root angiograms revealed intact valve function in all. Histology showed various degrees of damage and repair of AV junctional tissue. There were no valvular perforations. Transcatheter Nd:YAG laser photocoagulation of the AV junction from the aortic root is a fast, simple, and safe method for creating AV conduction block in dogs.

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Section: Discussionmentioning

confidence: 99%

“…Tbe presumed area of the His bundle and tbe summit of tbe intravenlricular septum are replaced by fibrocartilaginoas tissue fFCJ. Ao ^ aorta; CFB = central fibrous body; TV = tricuspid volve; RA = right afrium.FACE, Vol 16. March, Part I 1993 404A…”

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confidence: 99%