Animal studies of epicardial atrial ablation

Richard B. Schuessler, Anson M. Lee, Spencer J. Melby, Rochus K. Voeller, Sydney L. Gaynor, Shun Ichiro Sakamoto, Ralph J. Damiano

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

The Cox maze procedure is an effective treatment of atrial fibrillation, with a long-term freedom from recurrence greater than 90%. The original procedure was highly invasive and required cardiopulmonary bypass. Modifications of the procedure that eliminate the need for cardiopulmonary bypass have been proposed, including use of alternative energy sources to replace cut-and-sew lesions with lines of ablation made from the epicardium on the beating heart. This has been challenging because atrial wall muscle thickness is extremely variable, and the muscle can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices (four radiofrequency, two microwave, two lasers, one cryothermic) for creating continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. The maximum penetration of any device was 8.3 mm. All devices except one, the AtriCure Isolator pen, failed to penetrate 2 mm in some nontransmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration.

Original languageEnglish
Pages (from-to)S41-S45
JournalHeart rhythm
Volume6
Issue number12 SUPPL.
DOIs
StatePublished - Dec 2009

Keywords

  • Atrial fibrillation
  • Cox maze procedure
  • Epicardial ablation
  • Surgical treatment

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