Monitoring of laser effects on the conduction system by using an open-irrigated electrode-laser mapping and ablation catheter: laser catheter mapping

Weber, H; Sagerer-Gerhardt, Michaela

doi:10.1093/europace/euu328

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…In other words, electrophysiologically-guided laser catheter ablation allows for a systematic approach with simultaneous validation of initial success; a unique claim of the laser method when using the open-irrigated ELMA catheter. 16,17 Figure 8: Bipolar sinus nodal electrograms showing the largest sinus nodal electrical potential amplitudes (S: maximum 1.9 mm) found by mapping the entire sinus nodal area after two laser applications. I, II, aVF: surface lead ECG; P: P-wave; SCL: sinus cycle length.…”

Section: Discussionmentioning

confidence: 99%

Laser Catheter Modulation of the Sinus Node in the Treatment of Inappropriate Sinus Tachycardia: Experimental and Clinical Results

Weber

Heinze

Ruprecht

et al. 2018

J Innov Cardiac Rhythm Manage.

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Inappropriate sinus tachycardia (IST) is a rare type of arrhythmia that is currently difficult to treat successfully. The effects of laser catheter applications aimed at the sinus nodal area were tested experimentally and the technique was used for the treatment of IST. Continuous-wave, mapping-guided 1,064 nm neodymium-doped yttrium aluminum garnet laser applications at 15 W (9.5 W/mm 2) per 15 seconds (142.5 J/mm 2) and an irrigation flow of 30 mL/min were aimed at the sinus nodal area in five dogs (three applications each) and one human patient (two applications) by use of an 8-French open-irrigated electrode-laser mapping and ablation (ELMA) catheter provided with three miniature pin electrodes (0.5 mm × 4.0 mm) with interelectrode distances of 2.0 mm arranged symmetrically and radially around the endhole of the catheter tip. Laser application was aimed at the largest and earliest atrial potentials recorded in the focused local electrograms 30 ms to 45 ms prior to the onset of the P-wave in the surface lead electrocardiogram. Lesions were evaluated morphometrically. Holter monitoring in the patient was performed prior to and after treatment. During laser application in the dogs, sinus nodal potential amplitudes dwindled gradually from a mean of 42 mm ± 24 mm to 5.0 mm ± 3.0 mm and sinus cycle lengths lengthened from 452 ms ± 35 ms to 634 ms ± 35 ms (p < 0.0001 for both). In the patient, electrical potential amplitudes in the local electrograms dwindled from 41.0 mm to 5.0 mm and, in the Holter monitor, heart rate decreased from 109 bpm ± 29 bpm to 79 bpm ± 26 bpm (p < 0.0001). IST ablation was painless and without complications. During a follow-up of 4.9 years, the patient was asymptomatic and her heart rate and chronotropic competence remained normal. In conclusion, ablation of IST was achieved by substrate mapping-guided laser application while using the open-irrigated EMLA catheter RytmoLas (LasCor GmbH-Laser Medical Devices, Taufkirchen, Germany). However, this is a proof-of-concept study and further research, preferably in the form of multicenter study trials, is needed for confirmation of the results.

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Section: Discussionmentioning

confidence: 99%

Laser Catheter Modulation of the Sinus Node in the Treatment of Inappropriate Sinus Tachycardia: Experimental and Clinical Results

Weber

Heinze

Ruprecht

et al. 2018

J Innov Cardiac Rhythm Manage.

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“…Acute transmural atrial laser lesions of coagulation necrosis, once achieved, will result in a chronic scar that will be permanently devoid of electrical activity. 17,[21][22][23] The SLLS together with online control of electrical potential amplitudes in the focused LEG during laser application may help to protect all of the mediastinal structures from thermal injury and may substantially contribute to the safety and efficacy of the ablation procedure. The SLLS prevents further increase of the mediastinal temperature when overheating is imminent, prior to the occurrence of thermal damage to the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Use of Light Sensor and Focused Local Atrial Electrogram Recordings for the Monitoring of Thermal Injury to the Esophagus and Lungs During Laser Catheter Ablation of the Posterior Atrial Walls: Preclinical In Vitro Porcine and In Vivo Canine Experimental Studies

Weber¹,

Schaur²,

Sagerer-Gerhardt³

2019

J Innov Cardiac Rhythm Manage.

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During the catheter ablation of atrial fibrillation, thermal damages to the esophagus may have deleterious effects. The use of the SensoLas light sensor (SLLS; LasCor GmbH, Taufkirchen, Germany) and focused local atrial electrograms (LEGs) were tested as means for the assessment of thermal effects on the esophagus during laser catheter ablation. A total of 32 transcatheter in vitro and in vivo 1064-nm laser impacts were aimed at porcine (n = 16) and canine (n = 16) atrial endocardia. Photons scattering through the atrial and esophageal walls were captured by the SLLS, transmitted via an optical fiber to a diode, and converted to power displayed on a monitor. The laser was stopped automatically when the power measurement reached values beyond the preset upper limit. During in vivo laser applications, bipolar LEGs were recorded via the miniature electrodes of the laser catheter. Thermal damage to the esophagus was avoided when the power measurement was limited to 150 μW or less and the diode current was 60 μA or less, regardless of the energy setting used and regardless of the thicknesses of the atrial and esophageal walls. Laser energy applied for eight seconds to 13 seconds (average: 10 seconds) abolished the electrical potentials permanently. In conclusion, the control of laser light via the SLLS and of atrial potential amplitudes in the LEGs can prevent thermal esophageal and lung injury during laser catheter ablation.

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“…In addition, longer radiation times may result in an increase of variation in sizes and so in a wider standard deviation. However, during in vivo laser application, monitoring of local potential amplitudes allows for control of laser effects and for timely stop of radiation when local potentials are abolished [4,5]. The linear lesions were achieved by a stable positioning of the catheter for 30 s for each application.…”

Section: Discussionmentioning

confidence: 99%

“…Immediate and realtime verification of the success of treatment is extremely beneficial. Electrophysiologically guided laser ablation allows for a systematic approach with simultaneous validation of initial success [4,5]. Due to the homogenous distribution of the laser energy in the myocardium, lesions with well-demarcated boundaries are produced.…”

Section: Introductionmentioning

confidence: 99%

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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Monitoring of laser effects on the conduction system by using an open-irrigated electrode-laser mapping and ablation catheter: laser catheter mapping

Cited by 8 publications

References 19 publications

Laser Catheter Modulation of the Sinus Node in the Treatment of Inappropriate Sinus Tachycardia: Experimental and Clinical Results

Laser Catheter Modulation of the Sinus Node in the Treatment of Inappropriate Sinus Tachycardia: Experimental and Clinical Results

Use of Light Sensor and Focused Local Atrial Electrogram Recordings for the Monitoring of Thermal Injury to the Esophagus and Lungs During Laser Catheter Ablation of the Posterior Atrial Walls: Preclinical In Vitro Porcine and In Vivo Canine Experimental Studies

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

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