title: Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study.
abstract: Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters.
  
  
  
  Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters.
  
  
  
  Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium.
  
  
  
  Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Malini
authors: M
authors: Madhavan
authors: Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida.|Department of Surgical Research, Mayo Clinic, Rochester, Minnesota.
authors: K L
authors: KL
authors: Venkatachalam
authors: Heart Care Victoria, Melbourne, Australia.
authors: Matthew J
authors: MJ
authors: Swale
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Christopher V
authors: CV
authors: Desimone
authors: Oklahoma Heart Institute, Tulsa, Oklahoma.
authors: Joseph J
authors: JJ
authors: Gard
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Susan B
authors: SB
authors: Johnson
authors: Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota.
authors: Scott H
authors: SH
authors: Suddendorf
authors: Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota.
authors: Susan B
authors: SB
authors: Mikell
authors: Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota.
authors: Dorothy J
authors: DJ
authors: Ladewig
authors: Partner Project Leadership Services.
authors: Toni Grabinger
authors: TG
authors: Nosbush
authors: Mayo Clinic Health Solutions, Mayo Clinic, Rochester, Minnesota.
authors: Andrew J
authors: AJ
authors: Danielsen
authors: Mayo Clinic, Rochester, Minnesota.|EnteroMedics, Inc, St. Paul, Minnesota.
authors: Mark
authors: M
authors: Knudson
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Samuel J
authors: SJ
authors: Asirvatham
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D001341:Autonomic Nervous System; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004195:Disease Models, Animal; D004285:Dogs; D005240:Feasibility Studies; D010496:Pericardium / Q000294:innervation; D016896:Treatment Outcome
keywords: ablation; alcohol; atrial fibrillation; autonomic innervation; canine; direct current; epicardial; ganglionated plexus