Balloon electric shock ablation. A surgical technique for treatment of ventricular tachycardia: influence of endocardial scar on depth of ablation achieved.

Balloon electric shock ablation is a surgical technique that has been used for treatment of ventricular tachycardia. However, little is known about the energy requirements and precise electrode array best suited to achieve effective ablation of the target area while limiting injury to the surrounding myocardium. This study was designed to determine the effects of endocardial scar (often present at the "site of origin" of clinical ventricular tachycardia) on depth of ablation resulting from balloon electric shock ablation. A chronic canine model of endocardial scar (3.9 +/- 0.6 mm thick) was developed with the use of balloon electric shock ablation techniques. We compared depth of ablation achieved with balloon electric shock ablation with low-energy shocks (22 J per bead) in normal dogs versus those with chronic endocardial scar. No difference was found in depth of ablation in normal dogs and in the scar model (7.2 +/- 1.2 mm versus 6.2 +/- 1.0 mm). Depth of injury expressed as a percentage of wall thickness was not different in the two groups (61% +/- 11% versus 57% +/- 3%). We conclude that the presence of endocardial scar does not influence depth of injury resulting from balloon electric shock ablation. This data provides guidance for clinical application of the technique as a "closed heart" surgical approach for control of ventricular tachycardia. The data are also discussed in relation to energy levels currently used for direct current catheter ablation in patients with ventricular tachycardia.