Abstract 2863: Use of an Endoscopic Laser Balloon for Epicardial Mapping and Ablation in a Swine Model
Background: Epicardial (epi) mapping and ablation has numerous challenges, including poor catheter epi contact and the potential to damage epi vasculature and the phrenic nerve. The Cardiofocus endoscopic laser balloon ablation system (ELBAS) allows direct visualization of cardiac structures and ablation using light energy. We hypothesized that these features would be suited to epi mapping and ablation.
Methods: Percutaneous subxyphoid epi access was obtained in 6 swine (mean 65.8 kg). The ELBAS was advanced via a custom 15Fr steerable sheath into the epi space. The ability to steer the balloon, visualize epi vasculature, and ablate using a 30 degree spot arc at powers ranging from 8 to 25W for 20 – 60 secs was evaluated. Animals were acutely sacrificed.
Results: Epi access was obtained and the ELBAS was easily maneuvered throughout the epi space. Epi vessels were visualized on the anterior and lateral LV; basal fat was distinguishable from epi myocardium. Epi lesions (n=11) were oval shaped (mean length x width x depth =11.6 × 7.1 × 7.9 mm) due to cardiac motion during energy delivery. Energy delivery at the highest power (n=3, 25w) led to steam pops and had visible central necrosis. Lesions delivered at moderate (18W x 60 secs, Figure⇓) and low power (10W x 20 secs) were uniform in appearance without steam pops or necrosis. There was no evidence of phrenic nerve damage or pericardial effusion.
Conclusions: The endoscopic laser balloon has unique attributes that appear well suited to epi mapping and ablation. These include visualization of epi fat and vasculature, direct contact with the LV epi, displacement of the phrenic nerve, and large volume ablation lesions.