TY - JOUR
T1 - Swine atrioventricular node ablation using stereotactic radiosurgery
T2 - Methods and in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias
AU - Refaat, Marwan M.
AU - Ballout, Jad A.
AU - Zakka, Patrick
AU - Hotait, Mostafa
AU - Al Feghali, Karine A.
AU - Gheida, Ibrahim Abu
AU - Saade, Charbel
AU - Hourani, Mukbil
AU - Geara, Fady
AU - Tabbal, Malek
AU - Sfeir, Pierre
AU - Jalbout, Wassim
AU - Al-Jaroudi, Wael
AU - Jurjus, Abdo
AU - Youssef, Bassem
N1 - Publisher Copyright:
© 2017 The Authors.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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.
KW - Arrhythmia
KW - Atrioventricular node
KW - Atrioventricular node ablation
KW - Noninvasive ablation
KW - Stereotactic radiosurgery
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U2 - 10.1161/JAHA.117.007193
DO - 10.1161/JAHA.117.007193
M3 - Article
C2 - 29079566
AN - SCOPUS:85034772041
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e007193
ER -