An Innovative Balloon-Type Surgical Device for Atrial Fibrillation
Background. The maze procedure and its modifications are the surgical treatment for atrial fibrillation. In an attempt to achieve a less invasive operation, we developed a balloon-type device for electric pulmonary vein isolation and evaluated its effectiveness macroscopically and microscopically.
Methods. We created a left heart system model from 20 pigs. Based on a mold, a balloon was made with silicone resin. When this balloon was inflated, all pulmonary vein orifices were pressed and ablated by probes using radiofrequency and cryotherm as energy sources. Macroscopic and microscopic evaluations were performed.
Results. Complete circular ablation by radiofrequency was confirmed in 2 of 3 veins. The transmural denaturation was pathologically confirmed in all areas ablated at 80 for 2 minutes. The complete circular ablation line and the transmural denaturation were macroscopically and microscopically confirmed after cryoablation at -100 degrees for 2 minutes using liquid nitrogen.
Conclusions. This study proved that the balloon is effective in simplifying pulmonary vein isolation and has potential to become an instrument that contributes to less invasive operations in the near future.
Tanaka K, Satake S, Saito S, et al. 2001. A new radiofrequency thermal balloon catheter for pulmonary vein isolation. J Am Coll Cardiol 38:2079-86.nMaessen JG, Nijs JF, Smeets JL. et al. 2002. Beating-heart surgical treatment of atrial fibrillation with microwave ablation. Ann Thorac Surg 74:S1307-11.nCox JL, Ad N, Palazzo T, et al. 2000. Current status of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 12:15-9.nGillinov AM, Blackstone EH, McCarthy PM. 2002. Atrial fibrillation: current surgical options and their assessment [review]. Ann Thorac Surg 74:2210-17.nGillinov AM, McCarthy PM. 2002. Atricure bipolar radiofrequency clamp for intraoperative ablation of atrial fibrillation. Ann Thorac Surg 74:2165-8.nGuiraudon GM. 1987. Cryoablation, a versatile tool in arrhythmia surgery. Ann Thorac Surg 43:129-30.nCox JL. 1995. The modification of the maze procedure for atrial flutter and atrial fibrillation. I. J Thorac Cardiovasc Surg 110:473-84.nShepherd J, Dawber RP. 1982. The historical and scientific basis of cryosurgery. Clin Exp Dermatol 7:321-8.nOtt DA, Garson A, Cooley DA, Smith RT, Moak J. 1987. Cryoablative techniques in the treatment of cardiac tachyarrhythmias. Ann Thorac Surg 43:138-43.nKhairy P, Chauvet P, Lehmann J, et al. 2003. Lower incidence thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 107:2045-50.nKeane D, Ruskin JN. 1999. Linear atrial ablation with a diode laser and fiberoptic catheter. Circulation 100:e59-60.nCox JL. 1991. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg 101:584-92.nJais P, Weerasooriya R, Shah DC, et al. 2002. Ablation therapy for atrial fibrillation (AF): past, present and future. Cardiovasc Res 54:337-46.nSie HT, Beukema WP, Ramdat Misier AR, Elvan A, Ennema JJ, Wellens HJ. 2001. The radiofrequency modified maze procedure. A less invasive surgical approach to atrial fibrillation during open-heart surgery. Eur J Cardiothorac Surg 19:443-7.nSpitzer SG, Richter P, Kaunt M, Schuler S. 1999. Treatment of atrial fibrillation in open heart surgery-the potential role of microwave energy [review]. Thorac Cardiovasc Surg 3(Suppl):374-8.nRoithinger FX, Steiner PR, Goseki Y, Sparks PB, Lesh MD. 1999. Electrophysiologic effects of selective right versus left atrial linear lesions in a canine model of chronic atrial fibrillation. J Cardiovasc Electrophysiol 10:1564-74.nChen SA, Hsieh MH, Tai CT, et al. 1999. Initiation of atrial fibrillation by ectopic beats originating from pulmonary veins: electrophysiological characteristics, pharmacological response, and effect of radiofrequency ablation. Circulation 100:1879-86.nGaita F, Riccardi R, Calo L, et al. 1998. Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation. Electrophysiological findings and ablation results. Circulation 97:2136-45.nPrasad SM, Maniar HS, Schuessler RB, Damiano RJ. 2002. Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg 124:708-13.nVigilance DW, Williams M, Garrido M, et al. 2003. Atrial fibrillation surgery using linear laser technology [abstract]. Heart Surg Forum 6:121.nWonnell TL, Stauffer PR, Langberg JJ. 1992. Evaluation of microwave and radiofrequency ablation in a myocardium-equivalent phantom model. IEEE Trans Biomed Eng 39:1086-95.nNatale A, Posano E, Shewchik J, et al. 2000. First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation 102:1879-82.nIzuminoto H, Kawazoe K, Eishi K, Kamata J. 2000. Medium-term results after the modified Cox/Maze procedure combined with other cardiac surgery. Eur J Cardiothorac Surg 17:25-9.nHaissaguerre M, Lais P, Shah DC, et al. 1996. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 7:1132-44.nKlein GJ, Harrison L, Ideker RF, et al. 1979. Reaction of the myocardium to cryosurgery: electrophysiology and arrhythmogenic potential. Circulation 59:364-72.nHaissaguerre M. 1998. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New Eng J Med 339:659-66.nMazzitelli D, Park CH, Park KY. et al. 2002. Epicardial ablation of atrial fibrillation on the beating heart without cardiopulmonary bypass. Ann Thorac Surg 73:320-1.nNitta T, Lee R, Schuessler RB, Boineau JP, Cox JL. 1999. Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of procedure. Ann Thorac Surg 67:27-35.n