Epicardial application of laser energy in vivo: Acute arrhythmogenic potential

In order to assess the effect of laser energy on the heart’s rhythm, 7 newborn pigs each had 3 two-second applications of laser energy directly to the left ventricular epicardial surface. A quartz fiberoptic delivery system was used. All piglets (in all 21 applications) had ventricular arrhythmia induced. This varied from single premature ventricular contractions to sustained(112 seconds) ventricular tachycardia (6/7 piglets). The sustained ventricular tachycardia exhibited electrophysiologic criteria of a “re-entrant” mechanism. Fifteen minutes following lasing, programmed ventricular stimulation, a technique that indicates whether a substrate may be present for spontaneous re-entrant arrhythmias, showed induced arrhythmia in only 2/7 pigs, neither sustained. We conclude that epicardial application of laser energy frequently results in significant ventricular arrhythmia. This arrhythmia appears to be re-entrant in nature. However, shortly following lasing, sustained arrhythmia could not be induced. Therefore, we feel that more knowledge about the arrhythmogenic potential of laser lesions is needed prior to widespread clinical application.