Balloon electric shock ablation. Effects on ventricular structure, function, and electrophysiology.

Abstract

We have recently developed a transatrial balloon approach for intraoperative endocardial mapping of ventricular tachycardia, which can be performed in the intact ventricle. In selected patients, we have eliminated the arrhythmia by passing a series of electric currents through specific beads on the balloon array. The goal of this new technique, balloon electric shock ablation, is to create a homogenous scar in the subendocardial target area identified by mapping. Experimental data exist on the effects of catheter delivery of electric discharges to the myocardium, but no data are available on the effects of balloon electric shock ablation. We have performed balloon electric shock ablation in animals (nine cathodal shocks of 100 J given through a 4 cm2 electrode grid). Ventricular function was assessed at 6 weeks and compared with function after a simple ventriculotomy and with function in control animals having no operation. Gated nuclear ventriculograms were obtained during volume loading. Myocardial performance and diastolic pressure volume relationships were determined for the three groups. After balloon electric shock ablation or ventriculotomy, left atrial pressures were increased at similar end-diastolic volumes, which indicated decreased ventricular compliance. The trend reached statistical significance (compared with data from control animals) only in the group undergoing balloon electric shock ablation. Myocardial performance (stroke work index/end-diastolic volume relationship) was unchanged in the three groups. In the long-term balloon electric shock ablation preparation, an electrophysiologic study (including burst pacing) failed to induce ventricular arrhythmias. At 6 weeks, the lesion created by balloon electric shock ablation was a layer of homogenous mature scar with sharply defined borders. There was no evidence of additional injury to the surrounding myocardium or to the mitral valve apparatus. These studies show that delivery of a series of electric shocks through a 1 cm balloon grid of electrodes can create an area of homogeneous, electrically inert scar and that this procedure when performed in healthy dog hearts has no significant effect on the structure and function of the rest of the left ventricle.