Abstract
Introduction: Permanent coronary artery damage is a hazardous complication of epicardial radiofrequency ablation. Irreversible electroporation (IRE) is a promising non-thermal ablation modality able to create deep myocardial lesions. We investigated the effect of epicardial circular IRE-ablation on luminal coronary artery diameter. Methods: In a porcine model (5 pigs, 60-75 kg), the pericardium was exposed using surgical subxiphoidal epicardial access. A custom deflectable octopolar 12 mm circular catheter with 2 mm ring electrodes was introduced in the pericardial space via a steerable sheath. After coronary angiography (CAG), mid and distal LAD and RCx arteries were targeted with IRE-ablation. A single, non-arcing, non-barotraumatic, cathodal 200 J application was delivered. After IRE-ablation and after 3 months follow-up, CAG was repeated. Luminal diameters of the artery proximal and distal to the lesion site were averaged with use of quantitative CAG (Q-CAG) and used as reference. Minimal luminal diameter at the lesion site was calculated with use of Q-CAG. Lesion width and depth were measured at autopsy. Results: CAG directly post-ablation demonstrated short-lasting luminal narrowing with normalization in the targeted area, suggestive of coronary spasm. After 3 months survival, all CAGs were identical to pre-ablation CAGs: mean reference luminal diameter was 2.3±0.4 mm, mean luminal diameter at the lesion site was 2.3±0.5 mm (p=0.822). Inspection at autopsy demonstrated presence of extensive epicardial lesions. Median lesion width and depth were 25 and 8 mm. ![Figure][1] Catheter position over LAD and RCx Conclusion: Luminal coronary artery diameter remained unaffected 3 months after epicardial IRE-ablation, purposely targeting the coronary arteries. IRE-ablation is a safe modality for catheter ablation on or near coronary arteries. [1]: pending:yes
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