Myocardial Lesion Depth With Circular Electroporation Ablation

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 5; no. 3; pp. 581 - 586
• Main Authors: Wittkampf, Fred H.M, van Driel, Vincent J, van Wessel, Harry, Neven, Kars G.E.J, Gründeman, Paul F, Vink, Aryan, Loh, Peter, Doevendans, Pieter A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.06.2012; Lippincott Williams & Wilkins
• Subjects: Animals; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - methods; Disease Models, Animal; Electroporation; Heart; Heart Ventricles - pathology; Heart Ventricles - surgery; Medical sciences; Myocardium - pathology; Pericardium - pathology; Pericardium - surgery; Swine; Tachycardia, Ventricular - pathology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Arrhythmia; Atrial fibrillation; Catheter; Cardiovascular disease; Electroporation; Ventricular tachycardia; catheter ablation; Ablation; Excitability disorder; Depth; Heart disease; Myocardium; Lesion
• ISSN: 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.111.970079

BACKGROUND—Recently, we demonstrated the feasibility and safety of circular electroporation ablation in porcine pulmonary vein ostia, but the relationship between the magnitude of the application and lesion dimensions is still unknown. METHODS AND RESULTS—An in vivo porcine study was performed on left ventricular epicardium submerged under 10 mm of blood, using devices that mimic a 20-mm-diameter 7F circular ablation catheter. Model D contained 10 separate electrodes, whereas model M consisted of 1 circular electrode. Ablations were performed at 50, 100, and 200 J with model D and at 100 J with model M. Lesion dimensions were measured after 3-week survival. All applications resulted in smooth voltage waveforms demonstrating the absence of vapor globe formation, arcing, and a pressure wave. Applications up to 100 J with model D resulted in separate lesions under the electrodes. At 200 J, continuous deep circular lesions were created despite the use of separate electrodes. There was a significant relationship between applied current and median lesion depth, with a slope of 0.17 mm/A. At 100 J, there was no difference in lesion depth or width between models D and M. The electrodes and ablation site directly after ablation showed no signs of thermal damage. CONCLUSIONS—In an epicardial porcine model with blood around the application site, continuous circular lesions, deep enough for electric pulmonary vein isolation, were created with a single circular 200-J application. Lesions were continuous despite the use of separate electrodes. Lesion depth increased with the magnitude of the application.