Killu Ammar M, Naksuk Niyada, Syed Faisal F, DeSimone Christopher V, Gaba Prakriti, Witt Chance, Ladewig Dorothy J, Suddendorf Scott H, Powers Joanne M, Satam Gaurav, Stárek Zdeněk, Kara Tomas, Wolf Jiří, Leinveber Pavel, Crha Michal, Novák Miroslav, Bruce Charles J, Friedman Paul A, Asirvatham Samuel J
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Mayo Medical School, Rochester, MN, USA.
J Interv Card Electrophysiol. 2018 Oct;53(1):105-113. doi: 10.1007/s10840-018-0404-5. Epub 2018 Jul 14.
To demonstrate the feasibility of directional percutaneous epicardial ablation using a partially insulated catheter.
Partially insulated catheter prototypes were tested in 12 (6 canine, 6 porcine) animal studies in two centers. Prototypes had interspersed windows to enable visualization of epicardial structures with ultrasound. Epicardial unipolar ablation and ablation between two electrodes was performed according to protocol (5-60 W power, 0-60 mls/min irrigation, 78 s mean duration).
Of 96 epicardial ablation attempts, unipolar ablation was delivered in 53.1%. Electrogram evidence of ablation, when analyzable, occurred in 75 of 79 (94.9%) therapies. Paired pre/post-ablation pacing threshold (N = 74) showed significant increase in pacing threshold post-ablation (0.9 to 2.6 mA, P < .0001). Arrhythmias occurred in 18 (18.8%) therapies (11 ventricular fibrillation, 7 ventricular tachycardia), mainly in pigs (72.2%). Coronary artery visualization was variably successful. No phrenic nerve injury was noted during or after ablation. Furthermore, there were minimal pericardial changes with ablation.
Epicardial ablation using a partially insulated catheter to confer epicardial directionality and protect the phrenic nerve seems feasible. Iterations with ultrasound windows may enable real-time epicardial surface visualization thus identifying coronary arteries at ablation sites. Further improvements, however, are necessary.
证明使用部分绝缘导管进行定向经皮心外膜消融的可行性。
在两个中心对12只动物（6只犬、6只猪）进行了部分绝缘导管原型测试。原型有散布的窗口，以便通过超声可视化心外膜结构。根据方案（功率5 - 60瓦、冲洗速度0 - 60毫升/分钟、平均持续时间78秒）进行心外膜单极消融和两个电极之间的消融。
在96次心外膜消融尝试中，单极消融占53.1%。可分析时，79次治疗中有75次（94.9%）有消融的电图证据。配对的消融前后起搏阈值（N = 74）显示消融后起搏阈值显著增加（从0.9毫安增至2.6毫安，P <.0001）。18次（18.8%）治疗中出现心律失常（11次室颤、7次室速），主要发生在猪身上（72.2%）。冠状动脉可视化的成功率各不相同。消融期间及之后未发现膈神经损伤。此外，消融引起的心包变化极小。
使用部分绝缘导管进行心外膜消融以实现心外膜方向性并保护膈神经似乎是可行的。带有超声窗口的迭代可能实现心外膜表面实时可视化，从而在消融部位识别冠状动脉。然而，仍需进一步改进。
