TY - JOUR
T1 - Selective tissue ablation using laser radiation at 355 nm in lead extraction by a hybrid catheter; A preliminary report
AU - Herzog, Amir
AU - Bogdan, Stefan
AU - Glikson, Michael
AU - Ishaaya, Amiel Abraham
AU - Love, Charles
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background: Current lead extraction (LE) devices can harm the blood vessel endothelium, increasing the risk of perforation. Objective Proof of concept for using a solid-state pulsed laser at 355 nm with a hybrid catheter in LE. Methods A hybrid catheter was used comprising optical fibers for the delivery of 355 nm laser pulses at 30 Hz and 6 J/cm2 combined with a blunt mechanical blade. Specific parameters were chosen to enable selectivity in ablation, thereby reducing the risk of blood vessel perforation. The design exploits differences in the mechanical properties of the fibrotic tissue and the normal blood vessel. Ex vivo ablation was performed to evaluate a hybrid catheter operation on various tissues. Two ex/in vivo pig studies used a free-floating electrode to which three bovine tendon pieces were glued. Finally, two in vivo dog model studies were performed on specimens with 4-5-year-old pacing lead implants, followed by a histopathology study. Results Catheter penetration rate in the ex vivo experiments was 0.1 mm/seconds for bovine tendon, 0.025 mm/seconds for porcine superior vena cava and 0.033 mm/seconds for porcine aorta. In the ex/in vivo pig study, the three tissue blocks were successfully dissected. In the in vivo dog study, the two leads were successfully extracted. In all in vivo tests, hemodynamic stability was maintained. Gross histopathology did not reveal any injury. Conclusions Ablation using 355 nm laser pulses in combination with a mechanical blunt blade may potentially constitute a viable alternative for LE.
AB - Background: Current lead extraction (LE) devices can harm the blood vessel endothelium, increasing the risk of perforation. Objective Proof of concept for using a solid-state pulsed laser at 355 nm with a hybrid catheter in LE. Methods A hybrid catheter was used comprising optical fibers for the delivery of 355 nm laser pulses at 30 Hz and 6 J/cm2 combined with a blunt mechanical blade. Specific parameters were chosen to enable selectivity in ablation, thereby reducing the risk of blood vessel perforation. The design exploits differences in the mechanical properties of the fibrotic tissue and the normal blood vessel. Ex vivo ablation was performed to evaluate a hybrid catheter operation on various tissues. Two ex/in vivo pig studies used a free-floating electrode to which three bovine tendon pieces were glued. Finally, two in vivo dog model studies were performed on specimens with 4-5-year-old pacing lead implants, followed by a histopathology study. Results Catheter penetration rate in the ex vivo experiments was 0.1 mm/seconds for bovine tendon, 0.025 mm/seconds for porcine superior vena cava and 0.033 mm/seconds for porcine aorta. In the ex/in vivo pig study, the three tissue blocks were successfully dissected. In the in vivo dog study, the two leads were successfully extracted. In all in vivo tests, hemodynamic stability was maintained. Gross histopathology did not reveal any injury. Conclusions Ablation using 355 nm laser pulses in combination with a mechanical blunt blade may potentially constitute a viable alternative for LE.
KW - 355 nm
KW - catheter ablation
KW - implantable cardioverter-defibrillator
KW - lead extraction
UR - http://www.scopus.com/inward/record.url?scp=84952685136&partnerID=8YFLogxK
U2 - 10.1002/lsm.22451
DO - 10.1002/lsm.22451
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C2 - 26696586
AN - SCOPUS:84952685136
SN - 0196-8092
VL - 48
SP - 281
EP - 287
JO - Lasers in Surgery and Medicine
JF - Lasers in Surgery and Medicine
IS - 3
ER -