Heart Rhythm
Volume 5, Issue 8 , Pages 1115-1119, August 2008

Feasibility of endoscopic guidance for nonsurgical transthoracic atrial and ventricular epicardial ablation

  • Saman Nazarian, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Saman Nazarian, Division of Cardiology/Cardiac Arrhythmia, Johns Hopkins Hospital, Carnegie 592C, 600 North Wolfe Street, Baltimore, Maryland 21287.
    • ,
  • Sergey V. Kantsevoy, MD, PhD

      Affiliations

    • Department of Medicine, Divisions of Cardiology and Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
    • ,
  • Menekhem M. Zviman, PhD
    • ,
  • Fredrick A. Matsen III, MD

      Affiliations

    • Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington.
    • ,
  • Hugh Calkins, MD, FHRS
    • ,
  • Ronald D. Berger, MD, PhD, FHRS
    • ,
  • Henry R. Halperin, MD, MA, FHRS

Received 19 March 2008; accepted 6 May 2008. published online 12 May 2008.

Background

Epicardial catheter ablation via subxiphoid percutaneous access currently is used upon failure of endocardial catheter ablation. The safety, efficacy, and applicability of epicardial catheter ablation likely will improve with direct visualization of the pericardial space.

Objective

The purpose of this study was to assess the feasibility of percutaneous endoscopic guidance for identification of epicardial anatomic landmarks and epicardial catheter ablation.

Methods

Dual subxiphoid epicardial access and femoral venous and arterial access were obtained in six healthy swine. The endoscope and electrophysiology catheter were advanced to the pericardial space. Anatomic landmarks were identified via endoscopy and confirmed by multiview fluoroscopic assessment of proximity to endocardial catheters in the area of interest. Radiofrequency ablation of selected anatomic targets was performed under endoscopic guidance. Targeting of lesions was assessed by pathologic examination of the target and surrounding structures.

Results

Dual large-bore subxiphoid epicardial access was obtained without complications in all animals. The coronary sinus, left anterior descending coronary artery, left atrial appendage, and pulmonary veins were easily visualized in all animals. Catheter ablation of anatomic targets, including the right ventricular outflow tract, left atrial appendage, and pulmonary veins, was performed successfully under direct endoscopic observation. Endoscopic guidance of point and linear lesions near coronary vessels also was assessed. Pathology revealed successful targeting of lesions.

Conclusion

Endoscopic guidance of percutaneous epicardial electrophysiologic procedures is feasible. Direct visualization of epicardial structures, catheters, and lesions may improve the safety and efficacy of epicardial catheter ablation and reduce staff and patient radiation exposure.

Keywords: Epicardial ablation, Endoscopy, Electrophysiologic study, Pericardial space

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 The study was funded through the P.J. Schafer Memorial Research Grant to Dr. Nazarian, the Johns Hopkins Richard S. Ross Clinician Scientist Award to Dr. Nazarian, and National Institutes of Health Grant R01-HL65795 to Dr. Halperin. Drs. Halperin and Berger serve as scientific advisors for Boston Scientific Inc. Dr. Kantsevoy holds equity in Apollo Endosurgery Inc. The Johns Hopkins University Advisory Committee on Conflict of Interest manages all commercial arrangements.

PII: S1547-5271(08)00491-8

doi:10.1016/j.hrthm.2008.05.004

Heart Rhythm
Volume 5, Issue 8 , Pages 1115-1119, August 2008

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