New perspectives on catheter-based ablation of ventricular tachycardia complicating Chagas' disease: experimental evidence of the efficacy of near infrared lasers for catheter ablation of Chagas' VT.

Chronic Chagas' myocarditis can alter the myocardial substrate in a way that facilitates the emergence of fatal VT in a way similar to the long-term consequences of myocardial infarction. Post-myocardial infarction and Chagas' VT share many similarities: they are both macroreentrant circuits, entrainable, involving any wall segment from the endocardium to the epicardium. However, as compared to patients with post-MI VT, Chagasic patients tend to be younger and have a higher left ventricular ejection fraction. It is assumed, therefore, that their prognosis is closely related to VT treatment rather than the progression of the myocardial damage caused by the disease itself. Although sudden death is a rare event in patients in NYHA functional class I and II treated with amiodarone, VT recurrence rate is 30% a year. Drug therapy is ineffective for patients with advanced heart failure (100% recurrence rate/40% mortality in 1 year). Open-chest surgery is effective but requires very specialized centers and great expertise making its widespread use unrealistic. The results of combining RF endo/epicardial catheter ablation are still disappointing. Thus, research protocols on the search for new ablation technologies may greatly impact overall mortality in this subset of patients. This review will focus on the limitations of the current catheter-based ablation technology and suggest that an alternative approach is urgently needed. Experimental evidence of the efficacy of near infrared Lasers for catheter ablation will be reported along with investigations of the optical properties of the chagasic myocardium in the near infrared region to indicate that it might be not only feasible but also an appropriate choice to treat these patients.

Dielectrical spectroscopy of canine myocardium during acute ischemia and hypoxia at frequency spectrum from 100 kHz to 6 GHz.

We studied dielectrical properties of canine myocardium during acute ischemia and hypoxia using dielectrical spectroscopy method at frequency spectrum from 100 kHz to 6 GHz. This study was conducted on a group of six canines with acute ischemia and seven canines with hypoxia. Hypoxia (10% for 30 min) decreases myocardial resistance (rho), while the dielectrical permittivity (epsilon') of the myocardial tissue remains statistically unchanged. Acute ischemia for 2 hr causes significant frequency-dependent changes in both epsilon' and rho of myocardial tissue. Myocardial resistance increases, while the sign and amplitude of changes in the myocardial epsilon' are frequency and time dependent. These observations open up an opportunity for assessing the properties of myocardial tissue using dielectrical spectroscopy as well as noninvasively with the help of imaging methods based on electrical impedance and microwave tomography.