Advances in radiofrequency ablation of the cerebral cortex in primates using the venous system: Improvements for treating epilepsy with catheter ablation technology.
BACKGROUND
Pharmacology frequently fails for the treatment of epilepsy. Although surgical techniques are effective, these procedures are highly invasive. We describe feasibility and efficacy of minimally invasive mapping and ablation for the treatment of epilepsy.


METHODS
Mapping and radiofrequency ablations were performed via the venous system in eleven baboons and three dogs.


RESULTS
Mapping in deep cerebral areas was obtained in all animals. High-frequency pacing was able to induce seizure activity of local cerebral tissue in 72% of our attempts. Cerebral activity could be seen during mapping. Ablative lesions were deployed at deep brain sites without steam pops or sudden impedance rise. Histologic analysis showed necrosis at the sites of ablation in all primates.


CONCLUSIONS
Navigation through the cerebral venous system to map seizure activity is feasible. Radiofrequency energy can be delivered transvenously or transcortically to successfully ablate cortical tissue in this animal model using this innovative approach.
Instituto Brasília de Arritmia, Brasília, Brazil.
Benhur D
BD
Henz
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Paul A
PA
Friedman
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Charles J
CJ
Bruce
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
David R
DR
Holmes
Division of Neurology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Mark
M
Bower
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Malini
M
Madhavan
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Christopher V
CV
DeSimone
Access Point Technologies, Rogers, MN, United States.
Douglas
D
Wahnschaffe
Access Point Technologies, Rogers, MN, United States.
Steven
S
Berhow
Mayo Clinic, Rochester, MN, United States.
Andrew J
AJ
Danielsen
Mayo Clinic, Rochester, MN, United States.
Dorothy J
DJ
Ladewig
Mayo Clinic, Rochester, MN, United States.
Susan B
SB
Mikell
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Susan B
SB
Johnson
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Scott H
SH
Suddendorf
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States; ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, CZ, United States.
Tomas
T
Kara
Division of Neurology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Gregory A
GA
Worrell
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States; Department of Pediatrics and Adolescent Medicine Mayo Clinic, Rochester, MN, United States. Electronic address: asirvatham.samuel@mayo.edu.
Samuel J
SJ
Asirvatham
D000818:Animals; D001931:Brain Mapping; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004195:Disease Models, Animal; D004285:Dogs; D004827:Epilepsy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D060526:Magnetic Fields; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010215:Papio
Catheter ablation; Cerebral cortex; Epilepsy; Radiofrequency; Venous system