Minimally Invasive Delivery of Hydrogel-Encapsulated Amiodarone to the Epicardium Reduces Atrial Fibrillation

• Authors: Jose R. Garcia, Georgia Institute of Technology; Peter F. Campbell, Innovatie LifeSciences; Gautam Kumar, Emory University; Jonathan J Langberg, Emory University; Liliana Cesar, South Atlanta Veterinary Emergency Specialists; Juline N. Deppen, Georgia Institute of Technology; Eric Y. Shin, Emory University; Neil K. Bhatia, Emory University; Lanfang Wang, Emory University; Kai Xu, Emory University; Frank Schneider, Emory University; Brian Robinson, Emory University; Andres J. Garcia, Georgia Institute of Technology; Rebecca D. Levit, Emory University
• Journal Title: Circulation: Arrhythmia and Electrophysiology
• Volume: Volume 11, Number 5
• Publisher: American Heart Association | 2018-05-01, Pages e006408-e006408
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/CIRCEP.118.006408
• Subjects: Health Sciences, Medicine and Surgery; Engineering, Biomedical
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; amiodarone; arrhythmias, cardiac; atrial fibrillation; hydrogel, polyethylene glycol; pericardium; AMERICAN-HEART-ASSOCIATION; LONG-TERM TREATMENT; QUALITY-OF-LIFE; RHYTHM CONTROL; INTRAPERICARDIAL DELIVERY; FAILURE; EFFICACY; DESETHYLAMIODARONE; INFARCTION; METABOLITE

Abstract

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Although treatment options for AF exist, many patients cannot be maintained in normal sinus rhythm. Amiodarone is an effective medication for AF but has limited clinical utility because of off-target tissue toxicity. METHODS: Here, we use a pig model of AF to test the efficacy of an amiodarone-containing polyethylene glycol-based hydrogel. The gel is placed directly on the atrial epicardium through the pericardial space in a minimally invasive procedure using a specially designed catheter. RESULTS: Implantation of amiodarone-containing gel significantly reduced the duration of sustained AF at 21 and 28 days; inducibility of AF was reduced 14 and 21 days post-delivery. Off-target organ drug levels in the liver, lungs, thyroid, and fat were significantly reduced in animals treated with epicardial amiodarone gel compared with systemic controls in small-animal distribution studies. CONCLUSIONS: The pericardium is an underutilized therapeutic site and may be a new treatment strategy for AF and other cardiovascular diseases.