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Ann Thorac Surg 1985;39:201-206
© 1985 The Society of Thoracic Surgeons

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Articles

Laser Photoablation of Pathological Endocardium: In Vitro Findings Suggesting a New Approach to the Surgical Treatment of Refractory Arrhythmias and Restrictive Cardiomyopathy

From the Departments of Medicine, Pathology, and Surgery, Tufts-New England Medical Center, Boston, MA

Accepted for publication July 11, 1984.

^* Address reprint requests to Dr. Isner, New England Medical Center, 171 Harrison Ave, Box 70, Boston, MA 02111

In selected patients, malignant ventricular tachyarrhythmias have been successfully abolished by excision of subendocardial arrhythmogenic foci. Likewise, in certain patients in whom restrictive cardiomyopathy is due to endocardial thickening, endocardial resection has resulted in hemodynamic improvement. The present study was designed to explore the utility, in vitro, of laser photo-ablation of pathologically thickened endocardium. Endocardial photoablation was easily accomplished regardless of etiological or anatomical variations using either the focused beam of a carbon dioxide laser or argon laser light delivered through a 200-µm optical fiber. Photoablation of areas as large as 3.9 x 1.3 cm was performed within 40 seconds. The extent or depth of endocardial photoablation could be limited to 2 mm² in area or 1 mm in depth using either form of laser therapy. These in vitro results suggest that either carbon dioxide or argon laser phototherapy can be successfully applied to the surgical treatment of refractory arrhythmias and restrictive cardiomyopathy. Advantages of laser photoablation include speed and precision. Furthermore, laser photoablation obviates the difficulty associated with conventional techniques in establishing tissue planes.

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