Experimental study of laser ablation on lethal arrhythmias in dogs

To study the effect of laser ablation on arrhythmogenic ventricular myocardium, we applied aconitine on 36 local epicardial sites of ventricles (22 in LV, 14 in RV) in 12 dogs. Severe monographic persistent VTs or VFs were induced by aconitine and then these foci were irradiated by Nd: YAG laser. RV refractoriness (RVR) and local epicardial pacing threshold (LEPT) were measured by programmed electrical stimulation (PES) before aconitine applying and after resuming sinus rhythm. That VT or VF could not be induced by PES and the heart had persistent sinus rhythm was considered success. Aconitine doses were 7.9 +/- 4.8 micrograms in LV, 3.3 +/- 1.9 micrograms in RV, P less than 0.01. The data of time from aconitine applying to the appearance of VT were 237 +/- 228 s in LV and 148 +/- 101 s in RV, P less than 0.05. VF incidence rate was 75% (27/36). All of VT, VF could be abolished by mapping-guided laser irradiation on VT foci. The mean laser energy was 1542 +/- 893 joules (n = 36). RVR and LEPT increased significantly (P less than 0.001) after tests. Results showed that: (1) Lethal ventricular arrhythmias could be induced by giving little aconitine on the ventricular epicardium; (2) Mapping-guided lasering on arrhythmogenic myocardium could eradicate VT and VF; (3) RVR and LEPT would increase greatly after ablation.