Evaluation of a catheter technique for ablation of accessory pathways near the coronary sinus using a canine model.

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Abstract
The production of atrioventricular block by intracardiac discharges at up to 300 W-s delivered through standard electrophysiologic catheters is a safe and effective treatment for some patients with supraventricular tachycardias. The possibility that a similar technique using a catheter in the coronary sinus might be useful in ablating left-sided bypass tracts associated with the Wolff-Parkinson-White syndrome was evaluated. Acute studies involved 1 discharge of 35-45 J in the coronary sinus of 5 dogs; a 6th dog served as a control. These dogs were killed after 6 h of observation, during which they remained stable. Two and 3 discharges of 240 J were used in 2 dogs and caused profound local damage, including exsanguinating hemorrhage in 1. Chronic experiments also were conducted. Dogs (16) received 1-4, 35-45 J discharges in the middle coronary sinus and 2 dogs received 4 240-J discharges near the ostium of the coronary sinus. One dog suffered a small perforation of the coronary sinus; there was no significant hemorrhage, and the perforation was promptly sealed by thrombus formation. There were no clinical complications. All dogs recovered uneventfully and regained their usual vigor. Before sacrifice 2-11 wk later, cardiac catheterization, including coronary arteriography, biplane left ventricular angiography and pressure measurements, were performed; the results were normal in each dog. Gross and microscopic examination revealed fibrosis in the atrioventricular sulcus and atrial wall, and preservation of normal coronary anatomy in all but 3 dogs. The extent and distribution of the fibrosis suggested the possibilty of adapting this technique for the ablation of left-sided bypass tracts in patients with Wolff-Parkinson-White syndrome.

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