title: Direct Pulmonary Vein Ablation With Stenosis Prevention Therapy.
abstract: BACKGROUND
  The dominant location of electrical triggers for initiating atrial fibrillation (AF) originates from the muscle sleeves inside pulmonary veins (PVs). Currently, radiofrequency ablation (RFA) is performed outside of the PVs to isolate, rather than directly ablate these tissues, due to the risk of intraluminal PV stenosis.
  
  
  METHODS
  In 4 chronic canine experiments, we performed direct PV muscle sleeve RFA ± postablation drug-coated balloon (DCB) treatment with paclitaxel/everolimus. Of the 4 PVs, 2 PVs were ablated and treated with DCB, 1 PV was ablated without DCB treatment (positive control), and 1 PV was left as a negative control. Local electrograms were assessed in PVs for near-field signals and were targeted for ablation. After 12-14 weeks survival, PVs were interrogated for absence of near-field PV potentials, and each PV was assessed for stenosis.
  
  
  RESULTS
  All canines survived the study period without cardiorespiratory complications, and remained ambulatory. In all canines, PVs that were ablated and treated with DCB remained without any significant intraluminal stenosis. In contrast, PVs that were ablated and not treated with DCB showed near or complete intraluminal stenosis. At terminal study, PV potentials remained undetectable. A blinded, histologic analysis demonstrated that ablated PVs without DCB treatment had extensive thrombus, fibrin, mineralization, and elastin disruption.
  
  
  CONCLUSIONS
  Our chronic canine data suggest that direct PV tissue ablation without subsequent stenosis is feasible with the use of postablation DCBs.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: DeSIMONE
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ebrille
authors.affiliation: Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Faisal F
authors.initials: FF
authors.lastname: Syed
authors.affiliation: Mayo Clinic Ventures, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Ladewig
authors.affiliation: Mayo Clinic Ventures, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Mikell
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Powers
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Suddendorf
authors.affiliation: Mayo Clinic Ventures, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Gilles
authors.affiliation: Mayo Clinic Ventures, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Danielsen
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Suraj
authors.initials: S
authors.lastname: Kapa
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.|Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
keywords: anti-proliferative agent; atrial fibrillation; catheter ablation; neointimal hyperplasia; pulmonary vein isolation; pulmonary vein stenosis