Nonthermal Cardiac Catheter Ablation Using Photodynamic Therapy
Nonthermal Cardiac Catheter Ablation Using Photodynamic Therapy
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DOI：
10.1161/circep.113.000810
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发表时间：
2013-10-01
影响因子：
8.4
通讯作者：
Fukuda, Keiichi
中科院分区：
文献类型：
--
作者：
Kimura, Takehiro;Takatsuki, Seiji;Fukuda, Keiichi
背景射频消融有局限性，很大程度上与加热造成的损伤有关。在这里，我们报告了第一次使用定制的可偏转激光导管对心脏组织进行光动力治疗(PDT)的非热消融。本研究旨在探讨光动力疗法治疗犬三尖瓣峡部消融术的可行性。方法与结果：我们评价了17只犬在不同给药方案下给予光敏剂(他拉普芬钠)后的药代动力学。我们成功地将光敏剂浓度维持在超过人类临床有效剂量的水平。采用4极7法式可偏转激光导管，对8只犬进行了PDT介导的三尖瓣峡部消融术。光动力疗法仅对受照区域造成氧化损伤，并成功地产生了持续性的传导阻滞。照射后未观察到水肿性变性、血栓形成、蒸汽爆裂或创伤性损伤等急性肉眼变化。组织标本苏木精-伊红染色也显示内皮层保存完好。对手术前后采集的血液样本进行的测试显示，没有明显的变化。比较PDT和冲洗射频消融术后2周的病灶大小和照射期间收集的体温数据。脑室横切面显示实质的PDT病变，其深度与射频病变一样深。此外，PDT照射期间的心内膜、表面和室壁内温度监测清楚地表明了消融技术的非热性。结论非热性PDT介导的导管消融是一种潜在的治疗心律失常的新方法。
Background Radiofrequency ablation has limitations, largely related to creation of lesions by heating. Here, we report the first nonthermal ablation by applying photodynamic therapy (PDT) to cardiac tissues using a custom-made deflectable laser catheter. The present study investigated the feasibility of PDT for cavotricuspid isthmus ablation in a canine model.Methods and Results We evaluated the pharmacokinetic profiles of 17 canines after administration of a photosensitizer (talaporfin sodium) by various protocols. We succeeded in maintaining the photosensitizer concentration at a level in excess of the clinically effective dose for humans. Using a 4-polar 7-French deflectable laser catheter, we performed PDT-mediated cavotricuspid isthmus ablation in 8 canines. PDT caused oxidative injury only to the irradiated area and successfully produced a persistent electric conduction block. No acute, gross changes such as edematous degeneration, thrombus formation, steam pops, or traumatic injury were observed after irradiation. Hematoxylin and eosin staining of tissues samples also showed well-preserved endothelial layers. Testing of the blood samples taken before and after the procedure revealed no remarkable changes. Lesion size at 2 weeks after the procedure and the temperature data collected during irradiation were compared between the PDT and irrigated radiofrequency ablation procedures. A ventricular cross-section revealed a solid PDT lesion, which was as deep as a radiofrequency lesion. In addition, endocardial, surficial, and intramural temperature monitoring during the PDT irradiation clearly demonstrated the nonthermal nature of the ablation technique.Conclusions Nonthermal PDT-mediated catheter ablation is a potentially novel treatment for cardiac arrhythmias.