Swine atrioventricular node ablation using stereotactic radiosurgery: Methods and in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias

Marwan M. Refaat, Jad A. Ballout, Patrick Zakka, Mostafa Hotait, Karine A. Al Feghali, Ibrahim Abu Gheida, Charbel Saade, Mukbil Hourani, Fady Geara, Malek Tabbal, Pierre Sfeir, Wassim Jalbout, Wael Al-Jaroudi, Abdo Jurjus, Bassem Youssef

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background--Linear accelerator-based stereotactic radiosurgery delivered to cardiac arrhythmogenic foci could be a promising catheter-free ablation modality. We tested the feasibility of in vivo atrioventricular (AV) node ablation in swine using stereotactic radiosurgery. Methods and Results--Five Large White breed swine (weight 40-75 kg; 4 females) were studied. Single-chamber St Jude pacemakers were implanted in each pig. The pigs were placed under general anesthesia, and coronary/cardiac computed tomography simulation scans were performed to localize the AV node. Cone beam computed tomography was used for target positioning. Stereotactic radiosurgery doses ranging from 35 to 40 Gy were delivered by a linear accelerator to the AV node, and the pigs were followed up with weekly pacemaker interrogations to observe for potential electrocardiographic changes. Once changes were observed, the pigs were euthanized, and pathology specimens of various tissues, including the AV node and tissues surrounding the AV node, were taken to study the effects of radiation. All 5 pigs had disturbances of AV conduction with progressive transition into complete heart block. Macroscopic inspection did not reveal damage to the myocardium, and pigs had preserved systolic function on echocardiography. Immunostaining revealed fibrosis in the target region of the AV node, whereas no fibrosis was detected in the nontargeted regions. Conclusions--Catheter-free radioablation using linear accelerator-based stereotactic radiosurgery is feasible in an intact swine model.

Original languageEnglish (US)
Article numbere007193
JournalJournal of the American Heart Association
Volume6
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

Keywords

  • Arrhythmia
  • Atrioventricular node
  • Atrioventricular node ablation
  • Noninvasive ablation
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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