title: Initial experience with a novel focused ultrasound ablation system for ring ablation outside the pulmonary vein.
abstract: BACKGROUND
  Atrial fibrillation has been shown to initiate from triggers within pulmonary veins. Several studies have documented that electrical isolation of those triggers can lead to maintenance of sinus rhythm. The complication of pulmonary vein stenosis has limited the utility of delivering ablation energy within the pulmonary vein. We utilize a focused ultrasound catheter ablation system for delivery of transmural ablation lines proximal to the pulmonary vein ostium.
  
  
  METHODS
  Nine dogs (weight 30-39 kg) were anesthetized and ventilated. Through a transseptal approach, pulmonary veins were engaged with the focused balloon ultrasound catheter. Ultrasound power was delivered at 40 acoustic watts outside the pulmonary vein ostium, focused 2 mm off the balloon surface, with a depth of approximately 6 mm, for 30-120 seconds. Following ablation, lesions were histopathologically analyzed.
  
  
  RESULTS
  Of nine animals studied, fourteen pulmonary veins were ablated. We found successful delivery of near circumferential and transmural ablation lines in 6/14 pulmonary veins. In each of the six circumferential ablations, successful alignment of the ultrasound transducer along the longitudinal axis of the parabolic balloon occurred. The final four ablations were conducted with an enhanced catheter design that assured axial alignment. Of these ablations, all four were circumferential. The remaining 8 pulmonary veins had incomplete delivery of lesions. In each of these veins the ultrasound transducer was misaligned with the balloon axis when therapy was delivered.
  
  
  CONCLUSIONS
  Focused ultrasound ablation is a new means of performing pulmonary vein isolation. This method provides delivery of lesions outside the vein, limiting the risk of pulmonary vein stenosis for the treatment of atrial fibrillation.
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Jefferson Building Room 173, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Meininger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
authors.forename: Patrick
authors.initials: P
authors.lastname: Lopath
authors.forename: Todd
authors.initials: T
authors.lastname: Fjield
authors.forename: Robert
authors.initials: R
authors.lastname: Pacheco
authors.forename: Paul
authors.initials: P
authors.lastname: Harhen
authors.forename: E Rene
authors.initials: ER
authors.lastname: Rodriguez
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Henry
authors.initials: H
authors.lastname: Halperin
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004285:Dogs; D011667:Pulmonary Veins; D018084:Ultrasonography, Interventional