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Circulation: Arrhythmia and Electrophysiology

Clinical Articles, Lead Article

First non-thermal ablation using photodynamic therapy

Non-thermal photodynamic therapy (PDT)-mediated catheter ablation is a potentially novel treatment for cardiac arrhythmias, according to a report1 on the first non-thermal ablation using a custom-made deflectable laser catheter (Arai-Medphoton), published recently in Circulation: Arrhythmia and Electrophysiology.

Radiofrequency ablation has limitations, largely related to creation of lesions by heating, say the authors. They evaluated the pharmacokinetic profiles of 17 canines following administration of a photosensitizer (talaporfin sodium) by various protocols. The authors succeeded in maintaining the photosensitizer concentration at a level in excess of the clinically effective dose for humans.

Using a 4-polar 7-French deflectable laser catheter, the authors performed PDT-mediated cavotricuspid isthmus (CTI) ablation in eight canines. PDT caused oxidative injury only to the irradiated area and successfully produced a persistent electrical conduction block. No acute, gross changes such as edematous degeneration, thrombus formation, steam pops, or traumatic injury were observed after irradiation.

Lead investigator, Dr Takehiro Kimura (Keio University School of Medicine, Japan)

Lead investigator, Dr Takehiro Kimura (Keio University School of Medicine, Japan)

Haematoxylin and eosin (HE) staining of tissues samples also showed well-preserved endothelial layers. Testing of the blood samples taken before and after the procedure revealed no remarkable changes. Lesion size at two weeks after the procedure and the temperature data collected during irradiation were compared between the PDT and irrigated radiofrequency (RF) ablation procedures.

A ventricle cross-section revealed a solid PDT lesion, which was as deep as an RF lesion. In addition, endocardial, surface, and intramural temperature monitoring during the PDT irradiation clearly demonstrated the non-thermal nature of the ablation technique.

References

1. Kimura T, Takatsuki S, Miyoshi S, et al. Non-thermal cardiac catheter ablation using photodynamic therapy. Circ Arrhythm Electrophysiol 2013. http://dx.doi.org/10.1161/CIRCEP.113.000810

Published on: October 30, 2013

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  • Atrial Fibrillation Association
 

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