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Epicardium-based left atrial ablation: impact on electromechanical properties.

David Schwartzman1, Gianluca Bonanomi, Marco A Zenati

  • 1Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, PA, USA. schwartzmand@msx.upmc.edu

Journal of Cardiovascular Electrophysiology
|October 3, 2003
PubMed
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Epicardium-based left atrial (LA) ablation using a bipolar device successfully created transmural lesions without cardiopulmonary bypass. This novel approach demonstrated no adverse impact on global electromechanical properties, though regional function diminished.

Area of Science:

  • Cardiac Electrophysiology
  • Minimally Invasive Surgery
  • Medical Device Technology

Background:

  • Simplifying surgical ablation for atrial fibrillation is crucial.
  • Developing tools for effective lesions without cardiopulmonary bypass or atriotomy is a key goal.
  • Minimally invasive techniques should ideally preserve atrial electromechanical properties.

Purpose of the Study:

  • To characterize left atrial (LA) lesions created by epicardial bipolar ablation.
  • To assess the impact of these lesions on LA electromechanical properties.
  • To evaluate the feasibility of beating-heart ablation without cardiopulmonary bypass or atriotomy.

Main Methods:

  • Epicardial lesions were delivered to the beating heart in pigs using a bipolar device.

Related Experiment Videos

  • Pulmonary vein vestibules and atrial appendage were targeted.
  • LA electromechanical properties were assessed via endocardial mapping and intracardiac echocardiography before and after ablation.
  • Histologic analysis was performed postmortem.

    • Main Results:

    • Lesions were transmural, thrombus-free, barotrauma-free, and formed complete conduction barriers.
    • Despite excluding 24% of LA myocardium, global electromechanical properties remained unchanged.
    • Significant diminishment in atrial appendage function was observed.

    Conclusions:

    • Epicardium-based LA ablation in a beating heart is feasible without cardiopulmonary bypass or atriotomy.
    • The procedure did not adversely affect global LA electromechanical properties.
    • Regional functional diminishment, particularly in the appendage, was noted.