title: Linear lesions in myocardium created by Nd:YAG laser using diffusing optical fibers: in vitro and in vivo results.
abstract: OBJECTIVE
  Linear lesions may be necessary for successful catheter ablation of cardiac arrhythmias such as atrial fibrillation. This study uses laser energy delivered through diffusing optical fibers as an alternative to radiofrequency energy for the creation of linear lesions in cardiac tissue in a single application.
  
  
  METHODS
  Samples of canine myocardium were placed in a heated, circulating saline bath and irradiated with a 1.06-microm, continuous-wave Nd:YAG laser during in vitro studies. Laser ablation was then performed in vivo on the epicardial surface of the right ventricle during an open-chest procedure by using similar ablation parameters. Laser energy was delivered to the tissue by being diffused radially through flexible optical fiber tips oriented parallel to the tissue surface. Histology and temperature measurements verified transmurality, continuity, and linearity of the lesions.
  
  
  RESULTS
  Peak tissue temperatures measured in vitro remained low (51 +/- 1 degrees C at the endocardial surface, 61 +/- 6 degrees C in the mid-myocardium, and 55 +/- 6 degrees C at the epicardial surface) with no evidence of tissue charring or vaporization. Lesion dimensions produced in vitro and in vivo were similar (depth, 6 mm; width, 8-10 mm; length, 16-22 mm), demonstrating that tissue perfusion in vivo did not significantly alter the heating.
  
  
  CONCLUSIONS
  Long linear lesions, necessary for duplication of the surgical maze procedure during catheter ablation of atrial fibrillation, may be created by using laser radiation delivered through flexible diffusing optical fiber tips. Further development of steerable catheters for endocardial atrial ablation and studies correlating thermal damage zones with electrophysiologic indicators of irreversible conduction block are warranted.
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205, USA. nfried@bme.jhu.edu
authors.forename: N M
authors.initials: NM
authors.lastname: Fried
authors.forename: A C
authors.initials: AC
authors.lastname: Lardo
authors.forename: R D
authors.initials: RD
authors.lastname: Berger
authors.forename: H
authors.initials: H
authors.lastname: Calkins
authors.forename: H R
authors.initials: HR
authors.lastname: Halperin
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D001831:Body Temperature; D017115:Catheter Ablation / Q000379:methods*; D004285:Dogs; D005336:Fiber Optic Technology / Q000295:instrumentation; D053685:Laser Therapy / Q000295:instrumentation; D055100:Optical Fibers; D010496:Pericardium / Q000601:surgery