[The incidence of ventricular arrhythmia following direct current ablation, high-frequency current ablation and laser photo-ablation]
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G Hindricks1, W Haverkamp, U Dute
1Abt. Innere Medizin C, Westfälischen Wilhelms-Universität Münster.
Insights
Direct current ablation (DCA) frequently causes ventricular arrhythmias (VA) post-procedure, unlike radiofrequency-ablation (RFA) and laser-photoablation (LPA). RFA and LPA show lower risks of persistent VA after catheter ablation.
Area of Science:
- Cardiovascular Research
- Electrophysiology
- Medical Device Technology
Background:
- Transvenous catheter ablation is a common procedure for treating cardiac arrhythmias.
- The incidence and severity of post-ablation ventricular arrhythmias (VA) require further investigation.
- Different ablation modalities may have varying risks for inducing arrhythmias.
Purpose of the Study:
- To compare the incidence of ventricular arrhythmias (VA) after direct current ablation (DCA), radiofrequency ablation (RFA), and laser-photoablation (LPA).
- To evaluate the severity and persistence of arrhythmias induced by different ablation techniques.
Main Methods:
- Experiments were conducted on 26 anesthetized mongrel dogs.
- Unipolar ablation was performed using DCA and RFA via a 6F catheter.
- Laser-photoablation (LPA) was delivered using a quartz core fiber catheter.
- Ablation energies were applied to the left ventricular endocardium.
Main Results:
- Direct current ablation (DCA) induced ventricular tachycardia (VT) in 13/14 dogs, with two progressing to ventricular fibrillation.
- Persistent VA, including accelerated idioventricular rhythm, occurred in 12 dogs post-DCA.
- Radiofrequency ablation (RFA) and laser-photoablation (LPA) induced transient ventricular arrhythmias (salvoes, non-sustained VT), with one instance of ventricular fibrillation during RFA.
- No persistent arrhythmias were observed after RFA or LPA.
Conclusions:
- Direct current ablation (DCA) is associated with a high incidence of persistent ventricular arrhythmias (VA) post-procedure.
- Radiofrequency ablation (RFA) and laser-photoablation (LPA) demonstrate a lower risk profile for inducing sustained or persistent VA compared to DCA.
- These findings suggest RFA and LPA may be safer alternatives regarding post-ablation arrhythmia induction.
Abstract:
Incidence and severity of ventricular arrhythmias (VA) following transvenous catheter ablation have so far not been fully elucidated. In the present study we evaluated the comparative incidence of postablation ventricular arrhythmias following high voltage-direct current electrical ablation (DCA), radiofrequency-ablation (RFA), and laser-photoablation (LPA). Experiments were performed on a total of 26 anesthetized mongrel dogs (BW: 20-30 kg). DCA (n = 14; 150-200 J) and RFA (n = 7; 38.5-72.5 J) were performed unipolarly via a 6F USCI catheter, LPA (n = 5; 40-80 J) was delivered through a quarz core fiber (diameter 0.4 mm) housed within a special designed catheter. Energies were delivered to various sites of free wall and apical endocardium of the left ventricle. Immediately after DCA fast runs of ventricular tachycardia (VT) developed in 13 out of 14 dogs degenerating into ventricular fibrillation in two animals. Mean cycle length of induced VT was 298 +/- 86 ms. Persistent VA, morphologically mainly characterized by an accelerated idioventricular rhythm interrupted by runs of ventricular salvoes, occurred in 12 animals (mean rate: 78 +/- 13 VPB/min 3 h after ablation). During VT early endocardial activations were recorded from the ablation site. No significant correlation between total applied energy (150-550 J) and incidence of arrhythmogenic effects was observed. RFA and LPA induced ventricular salvoes and runs of non-sustained ventricular tachycardia, in one animal ventricular fibrillation occurred during RFA; however, no persistent arrhythmic activity developed after RFA and LPA, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)