Epicardially Based Pulmonary Vein Isolation for the Treatment of Atrial Fibrillation Utilizing Laser Energy in the Pig Model.

Purpose: Atrial fibrillation is a common disease that increases the incidence of cerebrovascular embolic events and cardiac dysfunction. Foci for atrial fibrillation have been mapped and found to be for the most part located within the ostia of the pulmonary veins. Since 2002 microwave and radiofrequency energy sources have been used to create pulmonary vein isolation lesions. This abstract summarizes the safety and efficacy of performing vein isolation lesions with laser as the energy source. Description: The large pig model was utilized for creation of isolation lesions around the pulmonary veins. The Optimaze E360 Surgical Ablation Handpiece from Edwards Lifesciences was utilized, it contains a 4 centimeter diffusing diode laser (980nm). All six of the pig models tolerated the procedure with a 40-day normal post procedure growth pattern. Evaluation: Upon reoperation one pig developed ventricular fibrillation with resection of adhesions. All five remaining pigs were fully tested and demonstrated complete electrical isolation. Gross pathology revealed intact well defined ablation lesions with an otherwise completely normal cardiac structure. All lesions were fully transmural at each histological sectioned point. Conclusions: Laser technology in the form of the Optimaze E360 Surgical Ablation Handpiece from Edwards Lifesciences, is able to reliably and consistently produce well defined electrical isolation scars around the pulmonary veins. This device is also amenable to performing the isolation procedure using a minimally invasive approach.