The Annals of Thoracic Surgery, Vol 39, 201-206, Copyright © 1985 by The Society of Thoracic Surgeons
Laser photoablation of pathological endocardium: in vitro findings suggesting a new approach to the surgical treatment of refractory arrhythmias and restrictive cardiomyopathy
JM Isner, H Michlewitz, RH Clarke, NA Estes 3d, RF Donaldson, DN Salem, I Bahn, DD Payne and RJ Cleveland
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 photoablation 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-microns 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.
