Editors' ChoiceCARDIAC ARRHYTHMIA

Beam me up, Scotty: The future of ablation

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Science Translational Medicine  04 Feb 2015:
Vol. 7, Issue 273, pp. 273ec23
DOI: 10.1126/scitranslmed.aaa5561

Cardiac arrhythmias occur when the heart cells beat out of sync. Most arrhythmias, including atrial tachycardia, atrial fibrillation, and ventricular tachycardia, can be managed with ablation—a process that kills tissues that are moving to the wrong beat. Although complication rates are generally low, ablation is an invasive procedure that requires the placement of multiple catheters in different positions inside the heart. Towards catheter-free ablation, Lehmann et al. investigated the use of ion beams. A previous study in animals showed the feasibility of targeting x-rays to specific cardiac locations. Lehmann et al. similarly used a radioactive energy source, carbon-12 ion beams,but were able to better focus on the intended site than x-ray. To test this method, they removed intact hearts from four pigs, perfused them on a Langendorff apparatus, and defibrillated them so they continued to function as if they were inside the body. Using CT images of the hearts, a 15-mm target sphere in the vicinity of the AV node (the structure where the atrial and ventricular conduction systems meet) was digitally identified. Radioactive 12C was then targeted at the AV node using a single beam that was configured to deposit radiation at the appropriate depth. Several doses were tested, with the highest dose achieving acute electrophysiologic effects similar to conventional catheter ablation.

Although this approach has yet to be tested in living animals, catheter-free ablation could have important clinical implications. Ultimately, this technique could be coupled with available methods for noninvasively defining arrhythmias, to ablate without making an incision or inserting a catheter. Such an approach would transform arrhythmia treatment, and make cardiac ablation of the future look like a scene out of Star Trek.

H. I. Lehmann et al., AV node ablation in Langendorff-perfused porcine hearts using carbon ion particle therapy: Methods and an in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias. Circ. Arrhythm. Electrophysiol. 10.1161/CIRCEP.114.002436 (2015). [Abstract]

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