Open-irrigated laser catheter ablation: relationship between the level of energy, myocardial thickness, and collateral damages in a dog model

Weber, H; Sagerer-Gerhardt, Michaela

doi:10.1093/europace/eut150

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…9 Of importance is also that, by adapting laser energy settings to the thickness of the myocardial wall, collateral damages such as esophageal fistulae, lung burns, and phrenic nerve palsy can be avoided. 10 Secondly, the open-irrigated ELMA catheter with its minielectrodes mounted at very narrow 2.0 mm interelectrode distances radially around the rim of the catheter endhole allows for the performance of high-resolution mapping by recording electrical potentials from a very Figure 4: Endocardial view of the sinus nodal area of a dog three months after laser applications performed at 15 W for 15 seconds aimed at the region wherein the earliest electrical activation was localized during catheter mapping. Clear-cut pale fibrous scars (circles) without aneurysm formation and without signs of tissue vaporization with crater formation can be seen.…”

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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“…12 It has been shown that catheter contact force is not a factor in whether a laser lesion is transmural, 10 and laser energy settings can be adjusted when ablating tissues of varying thickness, with higher energy applied to thicker tissue and lower energy applied to thinner structures in the heart. 8 The endocardial layers are translucent so that laser light passes through it without absorption of photons and without heating.…”

Section: Monitoring Of Laser Effects On the Conduction Systemmentioning

confidence: 99%

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

Weber¹,

Sagerer-Gerhardt

2015

Europace

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Monitoring of PAs recorded in the LEG via PE of the ELMA catheter during laser application is a unique claim of the laser method that enhances the assessment of local electrical activity and ablation efficacy. It allows the assessment of laser effects on the conduction system during ablation. By using the ELMA catheter described, long-term modulation of SN and AV nodal functions are achievable and unwanted complete heart block or fascicular block can be avoided.

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“…Catheter ablation for atrial fibrillation (AF) is a useful treatment option and has been offered as first-line therapy. 1 However, collateral damage to adjacent structures has previously been described, [2][3][4][5][6] including the formation of left atrioesophageal fistula, a rare but often fatal complication of catheter ablation for AF. 7 Several methods have been proposed to date for detecting and avoiding esophageal injury during left atrial (LA) catheter ablation, including fluoroscopic contrast visualization of the esophagus during the procedure 8 and temperature monitoring using various temperature probes.…”

Section: Introductionmentioning

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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Open-irrigated laser catheter ablation: relationship between the level of energy, myocardial thickness, and collateral damages in a dog model

Cited by 10 publications

References 15 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

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

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

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