Document Detail

Temporary occlusion of the great cardiac vein and coronary sinus to facilitate radiofrequency catheter ablation of the mitral isthmus.
MedLine Citation:
PMID:  18462328     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Ablation of the mitral isthmus to achieve bidirectional conduction block is technically challenging, and incomplete block slows isthmus conduction and is often proarrhythmic. The presence of the blood pool in the coronary venous system may act as a heat-sink, thereby attenuating transmural RF lesion formation. This porcine study tested the hypothesis that elimination of this heat-sink effect by complete air occlusion of the coronary sinus (CS) would facilitate transmural endocardial ablation at the mitral isthmus. METHODS: This study was performed in nine pigs using a 30 mm-long prototype linear CS balloon catheter able to occlude and displace the blood within the CS (the balloon was inflated with approximately 5 cc of air). Using a 3.5 mm irrigated catheter (35 W, 30 cc/min, 1 minute lesions), two sets of mitral isthmus ablation lines were placed per animal: one with the balloon deflated (CS open) and one inflated (CS Occluded). After ablation, gross pathological analysis of the linear lesions was performed. RESULTS: A total of 17 ablation lines were placed: 7 with CS Occlusion, and 10 without occlusion. Despite similar biophysical characteristics of the individual lesions, lesion transmurality was consistently noted only when using the air-filled CS balloon. CONCLUSIONS: Temporary displacement of the venous blood pool using an air-filled CS balloon permits transmurality of mitral isthmus ablation; this may obviate the need for ablation within the CS to achieve bidirectional mitral isthmus conduction.
Andre D'Avila; Aravinda Thiagalingam; Lori Foley; Melodie Fox; Jeremy N Ruskin; Vivek Y Reddy
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-05-06
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  19     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-30     Completed Date:  2008-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  645-50     Citation Subset:  IM    
Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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MeSH Terms
Atrial Fibrillation / physiopathology,  surgery*
Balloon Occlusion / methods*
Catheter Ablation / methods*
Coronary Sinus / physiopathology,  surgery*
Coronary Vessels / surgery*
Disease Models, Animal
Equipment Design
Heart Conduction System / physiopathology,  surgery*
Intraoperative Care / methods
Mitral Valve / innervation*,  surgery
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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