Low-energy transvenous ablation of the canine atrioventricular conduction system with a suction electrode catheter.

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Abstract
A single suction electrode catheter was used for His bundle electrogram recording. His bundle pacing, and low-energy (20 or 30 J) His bundle ablation in seven dogs. The suction electrode catheter was actively fixed to the atrial endocardium at the His bundle level. Electrophysiologic studies were performed in the control state, immediately after, and late (greater than 40 days) after His bundle ablation and results were correlated with histologic findings in the conduction system. Unipolar His bundle recording and pacing were successfully performed in all dogs with the suction electrode catheter before and after ablation. Complete heart block developed after a single 20 J shock delivered via the suction electrode catheter in all dogs immediately, but reverted to 1:1 atrioventricular conduction with first-degree atrioventricular block in two dogs in which one or two additional shocks (20 or 30 J) produced complete heart block. Mean ablation energy per shock was 22 +/- 4 J. The mean total delivered energy per dog was 31 +/- 20 J. Late electrophysiologic study in all dogs showed persistent complete heart block in five dogs and paroxysmal second-degree or third-degree atrioventricular block in two dogs. Gross examination of the ablation site showed a white plaque above the medial tricuspid leaflet (1.4 to 2.0 cm long and 0.4 to 0.6 cm wide). Microscopically, fibrosis of the penetrating and branching His bundle was seen in all dogs, with minimal atrioventricular node and atrial involvement. Significant proximal right bundle branch fibrosis was observed in the two dogs receiving one or two additional shocks. We conclude that the suction electrode catheter permits repeated His bundle recording, pacing, and ablation with a single catheter. Permanent and safe low-energy ablation of the canine His bundle is feasible. Focal injury localized to the target area in the conduction system can be obtained.