title: Safety and feasibility of closed chest epicardial catheter ablation using electroporation.
abstract: BACKGROUND
  Permanent coronary artery damage is a hazardous complication of epicardial radiofrequency ablation. Irreversible electroporation (IRE) is a promising nonthermal ablation modality able to create deep myocardial lesions. We investigated the effects of epicardial IRE on luminal coronary artery diameter and lesion depth.
  
  
  RESULTS
  In 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 pericardium via a steerable sheath. After coronary angiography (CAG), the proximal, mid, and distal left anterior descending, and circumflex coronary arteries were targeted with a single, cathodal 200 J application. CAG was repeated after IRE and after 3 months follow-up. Using quantitative CAG, the minimal luminal diameter at the lesion site was compared with the average of the diameters just proximal and distal to that lesion. Intimal hyperplasia and lesion size were measured histologically. CAG directly postablation demonstrated short-lasting luminal narrowing with normalization in the targeted area, suggestive of coronary spasm. After 3 months, all CAGs were identical to preablation CAGs: mean reference luminal diameter was 2.2±0.3 mm, mean luminal diameter at the lesion site was 2.1±0.3 mm (P=0.35). Average intimal hyperplasia in all arteries was 2±4%. Median lesion depth was 6.4±2.6 mm.
  
  
  CONCLUSIONS
  Luminal coronary artery diameter remained unaffected 3 months after epicardial IRE, purposely targeting the coronary arteries. IRE can create deep lesions and is a safe modality for catheter ablation on or near coronary arteries.
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.) kars_neven@hotmail.com.
authors.forename: Kars
authors.initials: K
authors.lastname: Neven
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.).
authors.forename: Vincent
authors.initials: V
authors.lastname: van Driel
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.).
authors.forename: Harry
authors.initials: H
authors.lastname: van Wessel
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.).
authors.forename: René
authors.initials: R
authors.lastname: van Es
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.).
authors.forename: Bastiaan
authors.initials: B
authors.lastname: du Pré
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.).
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.).
authors.forename: Fred
authors.initials: F
authors.lastname: Wittkampf
mesh_terms: D000818:Animals; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries; D018274:Electroporation / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D006965:Hyperplasia; D023421:Models, Animal; D009206:Myocardium / Q000473:pathology; D058426:Neointima; D018570:Risk Assessment; D012307:Risk Factors; D013552:Swine; D013997:Time Factors; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology
keywords: catheter ablation; coronary arteries; electroporation; pericardium; safety