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Park SY, Singh-Moon R, Yang H, Hendon C. Monitoring of irrigated lesion formation with single fiber based multispectral system using machine learning. JOURNAL OF BIOPHOTONICS 2022; 15:e202100374. [PMID: 35666015 PMCID: PMC9452461 DOI: 10.1002/jbio.202100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
In radiofrequency ablation (RFA) treatment of cardiac arrhythmias, intraprocedural assessment of treatment efficacy relies on indirect measures of adequate tissue destruction. Direct sensing of diffuse reflectance spectral changes at the ablation site using optically integrated RFA catheters has been shown to enable accurate prediction of lesion dimensions, ex vivo. Challenges of optical guidance can be due to obtaining reliable measurements under various catheter-tissue contact orientations. In this work, addressed this limitation by assessing the feasibility of monitoring lesion progression using single-fiber reflectance spectroscopy (SFRS). A total of 110 endocardial lesions of various sizes were generated in freshly excised swine right ventricular tissue using a custom-built, irrigated SFRS-RFA catheter. Models were developed for assessing catheter-tissue contact, the presence of nontransmural or transmural lesions and lesion depth percentage. These results support the use of SFRS-based catheters for irrigated lesion assessment and motivate further exploration of using multi-SFRS catheters for omnidirectionality.
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Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
| | - Rajinder Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
| | - Haiqiu Yang
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
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2
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Haman L, Pařízek P, Malý R, Duda J, Malý J. Analysis of Thrombotic Complications After Catheter Ablation. ACTA MEDICA (HRADEC KRÁLOVÉ) 2018. [DOI: 10.14712/18059694.2017.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Thromboembolic complications are described in about 1% of the patients undergoing radiofrequency catheter ablation (RFA). The aim of this study was to analyze thrombotic complications after RFA and to determine prothrombotic states in patients with thrombotic complications. Methods: We analyzed data from 400 patients (212 females) who underwent 453 RFA procedures for supraventricular tachycardias. Transthoracic echocardiography was performed one day before and after RFA in all patients. We evaluated the clinical and laboratory (in patients with thrombotic complications after RFA) risk factors of thromboembolism. Results: We observed thrombotic complication in 7 (1.75%) patients (6 females), thrice flail thrombus in the right atrium, flail thrombus in the inferior vena cava, femoral vein thrombosis with massive pulmonary embolism, femoral vein mural thrombus and upper extremity digital arteries embolization; four of them were asymptomatic. As a prothrombotic state we identified factor V Leiden mutation in one case and the use of oral contraceptives in two cases. Two other patients had a positive history of thromboembolic events. In a subgroup of females the use of oral contraceptives (p=0.13) or a positive history of thromboembolism (p=0.21) were not identified as important risk factors. Conclusion: Echocardiographic detection of asymptomatic thrombotic complications contributed to the higher percentage of these complications in our study. Although we can identify the risk factor (laboratory or clinical) in a majority of patients with a thromboembolic complication, occurrence of these complications is unpredictable.
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Han R, Liu X, Zheng M, Zhao R, Liu X, Yin X, Liu X, Tian Y, Shi L, Sun K, Yang X. Effect of remote ischemic preconditioning on left atrial remodeling and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:246-254. [PMID: 29315665 DOI: 10.1111/pace.13271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ruijuan Han
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
- Translational Medicine Research Center; Baotou Central Hospital, Inner Mongolia; Baotou 014040 China
| | - Xiaoqing Liu
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - Meili Zheng
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - RuiPing Zhao
- Translational Medicine Research Center; Baotou Central Hospital, Inner Mongolia; Baotou 014040 China
| | - XiaoYan Liu
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - Xiandong Yin
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - Xingpeng Liu
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - Ying Tian
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - Liang Shi
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
| | - Kai Sun
- Translational Medicine Research Center; Baotou Central Hospital, Inner Mongolia; Baotou 014040 China
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences; Peking Union Medical College, Xi-Cheng District; Beijing 100037 China
| | - Xinchun Yang
- Heart Center, Beijing Chao-Yang Hospital; Capital Medical University; Beijing 100020 China
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Lim B, Venkatachalam KL, Henz BD, Johnson SB, Jahangir A, Asirvatham SJ. Prevention of Coagulum Formation With Simultaneous Charge Delivery in Radiofrequency Ablation: A Canine Model. JACC Clin Electrophysiol 2016; 2:233-241. [PMID: 29766876 DOI: 10.1016/j.jacep.2015.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/23/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study reports on a novel method to prevent coagulum formation by continuously delivering a negative charge to the catheter tip to repel negatively charged fibrinogen molecules during RF ablation. BACKGROUND Radiofrequency (RF) ablation for cardiac arrhythmias is associated with a 70% incidence of coagulum formation on the catheter tip during ablation and a 10% incidence of thromboembolic events. Catheter tip thrombus can impede RF energy to the tissue, reducing efficacy and increasing procedure times. METHODS A novel circuit was built to deliver a negative, fixed-offset, direct current-based charge using a 9-V battery, placed in parallel with an RF delivery unit during RF ablation. In in vivo canine experiments, standard ablation catheters were advanced into atria and ventricles under fluoroscopic guidance. The presence of thrombus with and without RF delivery was identified with intracardiac echocardiography. RESULTS Scanning electron microscopy of the catheter tips showed clot coverage of the catheter tip to be 90% for noncharged catheters compared to 0% (p < 0.01) in negatively charged catheters. Volume of clot formed on the catheter tip decreased with increased amount of charge (140 ± 5.3 arbitrary units with no charge vs. 0 arbitrary units with a 100-μA current delivering negative charge, p < 0.01). Application of a negative charge did not affect the quality of the intracardiac electrogram or induce malignant ventricular arrhythmias. CONCLUSIONS Negative-charge delivery to ablation catheter tips and tissue during RF ablation is feasible and safe and can eliminate coagulum formation, potentially reducing thromboembolic complications.
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Affiliation(s)
- Bernard Lim
- Prairie Cardiovascular Consultants, Springfield, Illinois, USA.
| | - K L Venkatachalam
- Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Susan B Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Arshad Jahangir
- Aurora Health Care, Center for Integrative Research on Cardiovascular Aging (CIRCA), Milwaukee, Wisconsin, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Effect of Remote Ischemic Preconditioning on Platelet Activation and Reactivity Induced by Ablation for Atrial Fibrillation. Circulation 2014; 129:11-7. [DOI: 10.1161/circulationaha.113.005336] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency ablation of atrial fibrillation has been associated with some risk of thromboembolic events. Previous studies showed that preventive short episodes of forearm ischemia (remote ischemic preconditioning [IPC]) reduce exercise-induced platelet reactivity. In this study, we assessed whether remote IPC has any effect on platelet activation induced by radiofrequency ablation of atrial fibrillation.
Methods and Results—
We randomized 19 patients (age, 54.7±11 years; 17 male) undergoing radiofrequency catheter ablation of paroxysmal atrial fibrillation to receive remote IPC or sham intermittent forearm ischemia (control subjects) before the procedure. Blood venous samples were collected before and after remote IPC/sham ischemia, at the end of the ablation procedure, and 24 hours later. Platelet activation and reactivity were assessed by flow cytometry by measuring monocyte-platelet aggregate formation, platelet CD41 in the monocyte-platelet aggregate gate, and platelet CD41 and CD62 in the platelet gate in the absence and presence of ADP stimulation. At baseline, there were no differences between groups in platelet variables. Radiofrequency ablation induced platelet activation in both groups, which persisted after 24 hours. However, compared with control subjects, remote IPC patients showed a lower increase in all platelet variables, including monocyte-platelet aggregate formation (
P
<0.0001), CD41 in the monocyte-platelet aggregate gate (
P
=0.002), and CD41 (
P
<0.0001) and CD62 (
P
=0.002) in the platelet gate. Compared with control subjects, remote IPC was also associated with a significantly lower ADP-induced increase in all platelet markers.
Conclusions—
Our data show that remote IPC before radiofrequency catheter ablation for paroxysmal atrial fibrillation significantly reduces the increased platelet activation and reactivity associated with the procedure.
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Okumura Y. Which is the optimal therapy to prevent thromboembolism after atrial fibrillation ablation procedures in low stroke risk patients, anticoagulation or antiplatelet therapy? J Cardiovasc Electrophysiol 2009; 20:994-6. [PMID: 19549032 DOI: 10.1111/j.1540-8167.2009.01512.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kozlovaite V, Grybauskas P, Cimbolaityte J, Mongirdiene A, Puodziukynas A, Kazakevicius T, Ptasekas J. Influence of radiofrequency catheter ablation on platelet aggregation. Clin Appl Thromb Hemost 2007; 13:416-21. [PMID: 17911194 DOI: 10.1177/1076029607303612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this article was to find out how radiofrequency catheter ablation (RFA) influences platelet aggregation (PA), and the dependence on the total energy (TE) of RFA used and the cause of arrhythmia. We investigated 97 patients. PA was analyzed before, after, and in 24 hours after RFA. ADP- and epinephrine-induced PA significantly decreased after RFA by 5% and 8.9% (P < .001), respectively, and increased in 24 hours close to baseline. PA induced by ADP and collagen did not radically depend on the TE. Epinephrine-induced PA decreased after RFA by 0%, 8% (P < .05), and 16.9% (P < .01) in groups of patients where the TEs used were <4000 J, 4000 to 15,000 J, and >15,000 J, respectively. There were no significant differences in PA between groups based on the cause of arrhythmia. ADP- and epinephrine-induced PA significantly decreased after RFA and returned close to baseline in 24 hours. Epinephrine-induced PA was inversely associated with the TE used for RFA.
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Affiliation(s)
- Vilma Kozlovaite
- Institute of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania
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8
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Lickfett L, Hackenbroch M, Lewalter T, Selbach S, Schwab JO, Yang A, Balta O, Schrickel J, Bitzen A, Lüderitz B, Sommer T. Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation. J Cardiovasc Electrophysiol 2006; 17:1-7. [PMID: 16426390 DOI: 10.1111/j.1540-8167.2005.00279.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cerebral embolism and stroke are feared complications of left atrial catheter ablation such as pulmonary vein (PV) ablation. In order to assess the thrombogenicity of left atrial catheter ablation, knowledge of both clinically evident as well as silent cerebral embolism is important. The aim of the current study was to examine the use of diffusion-weighted magnetic resonance imaging (DW-MRI) for detection of cerebral embolism, apparent as well as silent, caused by PV catheter ablation. METHODS AND RESULTS Twenty consecutive patients without structural heart disease undergoing lasso catheter-guided ostial PV ablation using an irrigated-tip ablation catheter were studied. Cerebral MRI including DW single-shot spin echo echoplanar, turbo fluid attenuated inversion recovery, and T2-weighted turbo spin echo sequences were performed the day after the ablation procedure. Ten patients also underwent preprocedure cerebral MRI. All ablation procedures were performed without acute complications. A mean of 3.2 +/- 0.6 PVs were ablated per patient. No patient had neurological symptoms following the procedure. In 2 of 20 patients (10%), DW-MRI revealed new embolic lesions, which were located in the right periventricular white matter in one and in the left temporal lobe in the other patient. There was no statistically significant difference in age, history of hypertension, left atrial volume, and procedure duration between the 2 patients with and the 18 patients without cerebral embolism following AF ablation. CONCLUSION This is the first study using highly sensitive DW-MRI of the brain to detect asymptomatic cerebral embolism after left atrial catheter ablation. Even small, clinically silent, embolic lesions can be demonstrated with this technique. DW-MRI can be used to monitor and compare the thrombogenicity of different AF ablation approaches.
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Affiliation(s)
- Lars Lickfett
- Department of Medicine-Cardiology, University of Bonn, Bonn, Germany.
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9
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Wang LH, Jin ZM, Chen JZ, Zhu JH, Zheng LR, Tao QM, Zhang FR. Effect of heparin on activation of platelet function in patients during radiofrequency catheter ablation. Clin Exp Pharmacol Physiol 2006; 33:66-70. [PMID: 16445701 DOI: 10.1111/j.1440-1681.2006.04325.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
1. Thromboembolism occurs in 0.4-2.0% of patients undergoing radiofrequency catheter ablation (RFCA). Some studies have shown that treatment with heparin inhibits the activation of coagulation and fibrinolysis. No study has directly measured the activation of platelet aggregation to investigate the effect of heparin on platelet function. The purpose of the present study was to observe the inhibitory effect of heparin on platelet activity in patients undergoing RFCA. 2. Sixty-two patients with supraventricular tachycardia were observed and divided into a heparin-treatment group and a control group. Changes in platelet aggregability (PAG) and thromboxane B(2) (TXB(2)) in the blood samples of all patients at different times (before, after electrophysiological study, immediately after and 10 and 30 min after the RFCA procedure) were observed. 3. No indication of clinically symptomatic thromboembolism and no major differences in baseline characteristics and procedure were apparent in either group. The levels of PAG and TXB(2) were all clearly increased after the electrophysiological study (all P < 0.05). Immediately after RFCA, PAG and TXB(2) levels were significantly increased in both groups and remained elevated 30 min after the procedure (all P < 0.05). In the heparin-treatment group, the increases in PAG (54.69 +/- 3.24%) and TXB(2) (29.01 +/- 1.84%) caused by RFCA were lower than changes observed in the control group (70.92 +/- 3.45 and 44.70 +/- 3.28%, respectively; both P < 0.01). Moreover, treatment with heparin normalized the elevated level of PAG 30 min after RFCA more clearly. 4. The results of the present study suggest that intravenous heparin treatment during the operation inhibits the activation of platelets induced by RFCA.
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Affiliation(s)
- Li-Hong Wang
- Department of Cardiovascular Science, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China.
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10
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Asirvatham SJ, Friedman PA. Silent Cerebral Thromboembolism with Left Atrial Ablation: A Lurking Danger. J Cardiovasc Electrophysiol 2006; 17:8-10. [PMID: 16426391 DOI: 10.1111/j.1540-8167.2005.00337.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tse HF, Kwong YL, Lau CP. Transvenous Cryoablation Reduces Platelet Activation During Pulmonary Vein Ablation Compared with Radiofrequency Energy in Patients with Atrial Fibrillation. J Cardiovasc Electrophysiol 2005; 16:1064-70. [PMID: 16191116 DOI: 10.1111/j.1540-8167.2005.50103.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiofrequency (RF) ablation procedures for atrial fibrillation (AF) are associated with potential risks of thromboembolism, which may be minimized by the use of cryoablation that preserves the integrity of endocardium. The objective of this study was to compare the thrombogenic potential of transvenous cryoablation versus RF ablation during pulmonary vein (PV) isolation. METHODS AND RESULTS Thirty consecutive patients with paroxysmal AF were randomized to undergo segmental PV isolation procedure using 4-mm tip RF ablation (n = 15) or cryoablation (CryoCor, San Diego, CA, USA) (n = 15). Blood samples were drawn after sheath insertion (baseline), after transseptal puncture, before ablation (after heparin administration), and after isolation of a superior PV. Activation of coagulation was measured with plasma levels of prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), and platelets by plasma level of beta-thromboglobulin (beta-TG) and flow cytometric enumerating of P-selectin (CD62)-positive platelets. In both groups, the plasma level of beta-TG, F1 + 2, and TAT were elevated after sheath insertion. The percentage changes in plasma level of beta-TG, F1 + 2, and TAT and CD41/62-positive platelets from baseline after transseptal puncture and before ablation were similar (P > 0.05). However, the percentage changes in CD62-positive platelets from baseline were significantly higher in patients treated with RF ablation (82 +/- 20%) than with cryoablation (22 +/- 14%, P = 0.02), although their plasma levels of beta-TG, F1 + 2, and TAT were not different (P > 0.05). CONCLUSIONS Significant platelet and coagulation activations were observed during PV ablation procedures, and heparin administration only prevented activation of coagulation but not platelets. Persistent platelets activation was observed during RF energy application, but not during cryoablation.
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Affiliation(s)
- Hung-Fat Tse
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong.
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12
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Cauchemez B, Extramiana F, Cauchemez S, Cosson S, Zouzou H, Meddane M, d'Allonnes LR, Lavergne T, Leenhardt A, Coumel P, Houdart E. High‐Flow Perfusion of Sheaths for Prevention of Thromboembolic Complications During Complex Catheter Ablation in the Left Atrium. J Cardiovasc Electrophysiol 2004; 15:276-83. [PMID: 15030415 DOI: 10.1046/j.1540-8167.2004.03401.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Mechanisms for thromboembolic complications during complex ablation procedures in left atrium (LA) have not been defined. The aim of this study was to determine the effect of the perfusion rate of the transseptal sheath on the incidence of thromboembolic complications during catheter ablation for atrial fibrillation (AF) or LA macroreentrant tachycardia. METHODS AND RESULTS We analyzed clinical and procedural data from 86 consecutive patients (153 procedures) referred for catheter ablation of AF (74 patients) or LA macroreentrant tachycardia (12 patients). The transseptal sheath was continuously perfused at a low flow rate (3 mL/hour) for the first 32 patients and at a high flow rate (180 mL/hour) for the subsequent 54 patients. Ablation was mainly performed using map-guided isolation of pulmonary veins for AF and three-dimensional electroanatomic mapping for LA macroreentrant tachycardia. Five patients (6% of patients and 3.5% of procedures) developed a cerebral thromboembolic complication, all during procedures using low-flow perfusion. Sheath perfusion rate and total procedure duration were the two variables significantly associated with the occurrence of stroke (P = 0.013 and 0.001, respectively). After adjustment in a multivariable analysis, sheath perfusion rate remained the only risk factor for stroke. The risk was 17 times higher using low-flow than high-flow perfusion (odds ratio 17.26, 95% confidence interval 1.14-260.81, P = 0.04). No other clinical or procedural parameters had any significant effect. CONCLUSION Sheath perfusion rate is an important determinant of the risk factor for stroke during complex LA ablation procedures. Continuous high-flow perfusion appears to be effective in preventing this complication.
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Affiliation(s)
- Bruno Cauchemez
- Department of Cardiology, Lariboisière Hospital, Paris, France.
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Khairy P, Chauvet P, Lehmann J, Lambert J, Macle L, Tanguay JF, Sirois MG, Santoianni D, Dubuc M. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003; 107:2045-50. [PMID: 12668527 DOI: 10.1161/01.cir.0000058706.82623.a1] [Citation(s) in RCA: 348] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation is limited by thromboembolic complications. The objective of this study was to compare the incidence and characteristics of thrombi complicating RF and cryoenergy ablation, a novel technology for the catheter-based treatment of arrhythmias. METHODS AND RESULTS Ablation lesions (n=197) were performed in 22 mongrel dogs at right atrial, right ventricular, and left ventricular sites preselected by a randomized factorial design devised to compare RF ablation with cryocatheter configurations of varying sizes (7F and 9F), cooling rates (-1 degrees C/s, -5 degrees C/s, and -20 degrees C/s) and target temperatures (-55 degrees C and -75 degrees C). Animals were pretreated with acetylsalicylic acid and received intraprocedural intravenous unfractionated heparin. Seven days after ablation, the incidence of thrombus formation was significantly higher with RF than with cryoablation (75.8% versus 30.1%, P=0.0005). In a multiple regression model, RF energy remained an independent predictor of thrombus formation compared with cryoenergy (OR, 5.6; 95% CI, 1.7, 18.1; P=0.0042). Thrombus volume was also significantly greater with RF than with cryoablation (median, 2.8 versus 0.0 mm3; P<0.0001). More voluminous thrombi were associated with larger RF lesions, but cryolesion dimensions were not predictive of thrombus size. CONCLUSIONS RF energy is significantly more thrombogenic than cryoenergy, with a higher incidence of thrombus formation and larger thrombus volumes. The extent of hyperthermic tissue injury is positively correlated with thrombus bulk, whereas cryoenergy lesion size does not predict thrombus volume, most likely reflecting intact tissue ultrastructure with endothelial cell preservation.
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Affiliation(s)
- Paul Khairy
- Department of Electrophysiology, Montreal Heart Institute, Quebec, Canada
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14
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Manolis AS, Vassilikos V, Maounis TN, Chiladakis J, Cokkinos DV. Radiofrequency ablation in pediatric and adult patients: comparative results. J Interv Card Electrophysiol 2001; 5:443-53. [PMID: 11752913 DOI: 10.1023/a:1013254230114] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation has been widely and successfully employed to cure adult and pediatric patients of a variety of arrhythmias. Only limited data exist which compare the results in these two groups. The aim of this study was to compare the efficacy and safety of RF catheter ablation in pediatric versus adult patients performed by an adult electrophysiology (EP) team. METHODS The study group included 327 consecutive pediatric (n=47) and adult (n=280) patients, aged 7-82 years (mean 40+/-19), with symptomatic tachyarrhythmias, who underwent RF ablation during the last 6 years. All but ten patients underwent a full EP study during the same session. Procedures were performed in all but five patients with use of local anesthesia and deep or light sedation. The left heart was approached with use of transaortic (n=36) or transseptal (n=55) or both (n=6) techniques. RF ablation was performed for manifest or concealed accessory pathways in 132 patients, AV nodal slow pathway in 119, atrial tachycardia in 24, atrial flutter in 15, atrial fibrillation in one, ventricular tachycardia in 29, and AV node/His bundle in 7 patients. RESULTS RF ablation was successful in 271 (96.8%) patients in the adult group and in all patients (100%) in the pediatric group, with a mean of 15+/-18 (median: 8) vs 12+/-10 (median: 8) RF applications respectively (P=NS). Complications occurred in four patients (1.4%) in the adult group and in one patient (2.1%) in the pediatric group (P=NS). Fluoroscopy time averaged 43+/-40 min vs 39+/-27 min and procedures lasted for 3.0+/-1.9 hours vs 2.8+/-1.4 hours respectively (P=NS). During long-term follow-up of 25+/-19 months, there were 12 (4.4%) recurrences among the adult patients, and three (6.4%) recurrences in children, with nine of them successfully treated with repeat RF ablation. Procedural variables were dependent on the type of arrhythmia ablated, rather than on patient's age. Patients with multiple accessory pathways or atrial flutter required the greatest number of RF applications and the longest fluoroscopy exposure and duration of the procedure; the lowest values of these variables concerned ablation of the slow AV nodal pathway or the AV node/His bundle. CONCLUSION RF ablation in adult and pediatric patients performed by an adult EP team is equally efficacious and safe offering cure of symptomatic cardiac tachyarrhythmias in both patient populations.
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Affiliation(s)
- A S Manolis
- Cardiology Division, Patras University, Patras, Greece.
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15
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Zhou L, Keane D, Reed G, Ruskin J. Thromboembolic complications of cardiac radiofrequency catheter ablation: a review of the reported incidence, pathogenesis and current research directions. J Cardiovasc Electrophysiol 1999; 10:611-20. [PMID: 10355704 DOI: 10.1111/j.1540-8167.1999.tb00719.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radiofrequency catheter ablation (RFCA) has become established as an effective therapy for the treatment of many cardiac tachyarrhythmias. The principle limitation of conventional RFCA continues to be the risk of thromboembolism. This risk is of particular concern for the ongoing development of the catheter maze procedure for the treatment of atrial fibrillation, which currently involves the creation of extensive linear lesions in the left atrium. METHODS AND RESULTS A Medline search of the literature over the last ten years was performed. Focused review of the reported thromboembolic complications of RFCA indicates an overall incidence of 0.6%. However, the risk is increased when ablation is performed in the left heart (1.8% to 2%) and for ventricular tachycardia (2.8%). It is of concern that intravenous heparin and the use of temperature feedback to control radiofrequency current do not eliminate the risk of thromboembolic events. CONCLUSION The thromboembolic complications of RFCA are not eliminated by the treatment of intravenous herapin and mode of temperature control during ablation. Potential approaches to further reduce the risk of thromboembolism include the adjunctive administration of specific inhibitors of platelet activation and aggregation, intraprocedural intracardiac echocardiography, irrigated radiofrequency ablation, and cryoablation catheter systems.
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Affiliation(s)
- L Zhou
- Cardiac Unit, Massachusetts General Hospital and Cardiovascular Biology Laboratory, Harvard School of Public Health, Boston 02114, USA
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