His bundle ablation with the laser thermal probe ("hot tip"): a feasibility study.

Area of Science:

• Cardiovascular Medicine
• Medical Devices
• Electrophysiology

Background:

• Percutaneous ablation of the bundle of His requires precise localization and energy delivery.
• Conventional fiber optics struggle to direct laser energy effectively to the target site.
• A new approach is needed for controlled ablation of the bundle of His.

Purpose of the Study:

• To evaluate the efficacy and safety of a laser thermal probe for percutaneous ablation of the bundle of His.
• To assess the probe's ability to deliver controlled energy and minimize surrounding tissue damage.
• To determine the probe's suitability for use in electrophysiological studies.

Main Methods:

• A laser thermal probe with a heated metal cap was developed.
• The probe was tested on cadaver hearts using energy levels of 100-150 joules.
• The probe was modified for electrophysiological studies, recording unipolar electrograms from the metal cap.

Main Results:

• The laser thermal probe successfully damaged the bundle of His with minimal surrounding damage at 100-150 joules.
• Perforations in the right ventricular free wall and interventricular septum were <2.0 mm.
• Other structures like the AV membranous septum showed resistance, with perforations <1.0 mm.
• Electrograms confirmed accurate probe positioning adjacent to the bundle of His.

Conclusions:

• The laser thermal probe is a promising "self-directing" tool for precise ablation of the bundle of His.
• Further research is warranted to explore its clinical applications.
• The probe offers controlled energy delivery, potentially reducing complications in cardiac ablation procedures.