A new radiofrequency thermal balloon catheter for pulmonary vein isolation
Kazushi Tanaka, MDa,
Shutaro Satake, MDa,*,
Shigeru Saito, MD, FACCa,
Saeko Takahashi, MDa,
Yoshitaka Hiroe, MDa,
Yusuke Miyashita, MDa,
Shinji Tanaka, MDa,
Michio Tanaka, MDa and
Yoshio Watanabe, MD, FACCa
a Heart Center, Shonan Kamakura General Hospital, Kamakura and the Division of Pathology, Tokyo Metropolitan Hiro-o General Hospital, Tokyo, Japan
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Figure 1 The radiofrequency ablation transballoon catheter used in this study. (Top) Photograph of a balloon 1.5 cm in diameter, inflated with fluid and equipped near the distal end of the catheter. A coil electrode with a thermocouple sensor is mounted along the tube inside the balloon. (Bottom) This schematic illustration shows the balloon being wedged at the junction between the pulmonary vein and left atrium. The body of the catheter is 90 cm in length, and a 12F main shaft containing a 4F inner tube, as well as its central lumen, can accept a 0.035-in. guide wire. Shaded areas represent the ablated sites located at the pulmonary vein ostium. See text for details. RF = radiofrequency.
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Figure 2 Fluoroscopically optimal image of the balloon and the inferior pulmonary vein in the anteroposterior projection. Multiple arrows indicate the inflated balloon filled with a mixture of saline solution and contrast medium. An occlusive pulmonary venogram confirms that the balloon is firmly wedged into the pulmonary vein ring. ABL = ablation; CS = coronary sinus electrode catheter; PC = pigtail catheter; PV = inferior pulmonary vein.
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Figure 3 Disappearance of pulmonary vein (PV) "spike" potentials after successful radiofrequency ablation. Surface electrocardiographic leads I and II are simultaneously recorded with intracardiac electrograms from the coronary sinus (CS) (CSd and CSp [d = distal and p = proximal]) and the PV (PVd and PVo [o = ostium]). (Left) Before ablation, there are PV spike potentials (PV, upward arrows) on the PVd electrogram, which are unmasked and separated from the preceding low-amplitude, far-field atrial potentials by pacing (S) from the CSd. (Right) After ablation, the PV spikes are no longer seen during sinus rhythm. Note that the amplitude of the "A" potential in the PVo electrogram decreases. A = atrial potential; V = ventricular potential. See text for details.
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Figure 4 Macroscopic findings of the endocardial site after successful pulmonary vein (PV) isolation. The ablated lesion is relatively well demarcated (brownish in color) and located near the junction between the left atrium and PV trunks. Note that the ostia of the superior (S) and inferior (I) PVs are encircled by the ablated lesion. MA = mitral annulus. See text for details.
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Figure 5 Histologic findings of the identical case as in Figure 4. (Top) (low magnification), Transmural coagulation necrosis (N) is detected near the junction (curved portion) between the (LA) and the inferior pulmonary vein (PV) trunk. Atrial myocardial extension (Ex) (about 9 mm in length) spreads into the PV almost entirely and reaches near the right end of the panel. Fa = fat tissue; Ao = aorta. (Middle) (intermediate magnification), coagulation necrosis (N) in the LA myocardium and contraction band necrosis (CBN) in the proximal portion of the atrial myocardial extension into the PV. (Bottom) (high magnification), Coagulation necrosis (N) of muscle fibers located within the ablated LA. All specimens are in Azan stain.
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