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Piskarev Y, Sun Y, Righi M, Boehler Q, Chautems C, Fischer C, Nelson BJ, Shintake J, Floreano D. Fast-Response Variable-Stiffness Magnetic Catheters for Minimally Invasive Surgery. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2305537. [PMID: 38225742 DOI: 10.1002/advs.202305537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/13/2023] [Indexed: 01/17/2024]
Abstract
In minimally invasive surgery, such as cardiac ablation, magnetically steered catheters made of variable-stiffness materials can enable higher dexterity and higher force application to human tissue. However, the long transition time between soft and rigid states leads to a significant increase in procedure duration. Here, a fast-response, multisegmented catheter is described for minimally invasive surgery made of variable-stiffness thread (FRVST) that encapsulates a helical cooling channel. The rapid stiffness change in the FRVST, composed of a nontoxic shape memory polymer, is achieved by an active cooling system that pumps water through the helical channel. The FRVST displays a 66 times stiffness change and a 26 times transition enhancement compare with the noncooled version. The catheter allows for selective bending of each segment up to 127° in air and up to 76° in water under an 80 mT external magnetic field. The inner working channel can be used for cooling an ablation tip during a procedure and for information exchange via the deployment of wires or surgical tools.
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Affiliation(s)
- Yegor Piskarev
- Laboratory of Intelligent Systems, Institute of Mechanical Engineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - Yi Sun
- Laboratory of Intelligent Systems, Institute of Mechanical Engineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - Matteo Righi
- Laboratory of Intelligent Systems, Institute of Mechanical Engineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - Quentin Boehler
- Multi-Scale Robotics Lab, Tannenstrasse 3, ETH Zurich, Zurich, 8092, Switzerland
| | - Christophe Chautems
- Multi-Scale Robotics Lab, Tannenstrasse 3, ETH Zurich, Zurich, 8092, Switzerland
| | - Cedric Fischer
- Multi-Scale Robotics Lab, Tannenstrasse 3, ETH Zurich, Zurich, 8092, Switzerland
| | - Bradley J Nelson
- Multi-Scale Robotics Lab, Tannenstrasse 3, ETH Zurich, Zurich, 8092, Switzerland
| | - Jun Shintake
- Shintake Research Group, School of Informatics and Engineering, The University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo, 182-8585, Japan
| | - Dario Floreano
- Laboratory of Intelligent Systems, Institute of Mechanical Engineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
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Vitali F, De Raffele M, Malagù M, Balla C, Azzolini G, Gibiino F, Boccadoro A, Micillo M, Bertini M. Comparative Study of Lesions Obtained through Radiofrequency between the Irrigated Ablation Catheter with a Flexible Tip and the Non-Irrigated Catheter in Ex Vivo Porcine Hearts. BIOLOGY 2024; 13:132. [PMID: 38392350 PMCID: PMC10886553 DOI: 10.3390/biology13020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND At the same conditions of delivered power and contact force, open-irrigated radiofrequency ablation catheters are believed to create deeper lesions, while non-irrigated ones produce shallower lesions. This ex vivo study aims to directly compare the lesion dimensions and characteristics of an irrigated ablation catheter with a flexible tip and a non-irrigated solid-tip catheter. METHODS Radiofrequency lesions were induced on porcine myocardial slabs using both open-tip irrigated and non-irrigated standard 4 mm catheters at three power settings (20 W, 30 W, and 40 W), maintaining a fixed contact force of 10 gr. A lesion assessment was conducted including the lesion depth, depth at the maximum diameter, and lesion surface diameters, with the subsequent calculation of the lesion volume and area being undertaken. RESULTS Irrigated catheters produced lesions with significantly higher superficial widths at all power levels (3.8 vs. 4.4 mm at 20 W; 3.9 mm vs. 4.4 mm at 30 W; 3.8 mm vs. 4.5 mm at 40 W; p = 0.001, p = 0.019, p = 0.003, respectively). Non-irrigated catheters resulted in significantly higher superficial areas at all power levels (23 mm2 vs. 18 mm2 at 20 W; 25 mm2 vs. 19 mm2 at 30 W; 26 mm2 vs. 19 mm2 at 40 W; p = 0.001, p = 0.005, p = 0.001, respectively). Irrigated catheters showed significantly higher values of lesion maximum depth at 40 W (4.6 mm vs. 5.5 mm; p = 0.007), while non-irrigated catheters had a significantly higher calculated volume at 20 W (202 µL vs. 134 µL; p = 0.002). CONCLUSIONS Radiofrequency ablation using an irrigated catheter with a flexible tip has the potential to generate smaller superficial lesion areas compared with those obtained using a non-irrigated catheter.
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Affiliation(s)
- Francesco Vitali
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Martina De Raffele
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Michele Malagù
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Cristina Balla
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Giorgia Azzolini
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Federico Gibiino
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Alberto Boccadoro
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Marco Micillo
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
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Gorantla A, Alsaiqali M, Francois J, Sivakumar S, Freytes-Santiago L, Jallad A, Budzikowski AS. Comparative Effectiveness of Various Radiofrequency Ablation Catheters in the Ablation of Typical Atrial Flutter. Cardiol Ther 2023; 12:741-747. [PMID: 37864121 DOI: 10.1007/s40119-023-00336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION Although ablation of typical atrial flutter (AFL) can be easily achieved with radiofrequency energy (RF), no studies compare the effectiveness of different ablation catheters. Our study aimed to compare the efficacy of various types of ablation catheters in treating typical AFL. METHODS We analyzed patients with AFL who underwent RF ablation by a single operator at our institution. Successful ablation was evidenced by a bidirectional conduction block (trans-isthmus conduction time ≥ 130 ms or double potentials ≥ 90 ms). Logistic regression was used to compare success rate and linear regression to compare lesion time. RESULTS Out of 222 patients, only six did not meet the success criteria (2.7%). The catheters used were non-irrigated, large-tip, internally irrigated (Chili II Boston Scientific), and externally irrigated (non-force-sensing) catheters (Cool Path, Abbott). An externally irrigated force-sensing catheter (TactiCath, Abbott) was used with > 10 gm of force and (LPLD) setting (30 W- 45 °C- 60 s), and high-power short-duration (HPSD) setting (50 W- 43 °C - 12 s). No complications were encountered. The catheter type had no statistically significant association with ablation success. With the use of externally irrigated catheter with contract force-sensing and HPSD settings, statistically significantly shortening of lesion time was achieved 758.3 s, [CI - 1128.29, - 388.35 s] followed by LPLD by 419.0 s [CI - 808.49, - 29.47 s]. CONCLUSIONS The typical atrial flutter radiofrequency ablation procedure had a high success rate, which was not influenced by the type of ablation catheter. Contact force ablation catheter and HPSD are associated with shorter total lesion time.
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Affiliation(s)
- Asher Gorantla
- Department of Medicine, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Mahmoud Alsaiqali
- Department of Medicine, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Jonathan Francois
- Division of Cardiovascular Medicine-EP Section, SUNY Health Sciences University, 450 Clarkson Ave, Box 1199, Brooklyn, NY, 11203, USA
| | - Shruthi Sivakumar
- Department of Medicine, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Leonell Freytes-Santiago
- Division of Cardiovascular Medicine-EP Section, SUNY Health Sciences University, 450 Clarkson Ave, Box 1199, Brooklyn, NY, 11203, USA
| | - Ahmad Jallad
- Division of Cardiovascular Medicine-EP Section, SUNY Health Sciences University, 450 Clarkson Ave, Box 1199, Brooklyn, NY, 11203, USA
| | - Adam S Budzikowski
- Division of Cardiovascular Medicine-EP Section, SUNY Health Sciences University, 450 Clarkson Ave, Box 1199, Brooklyn, NY, 11203, USA.
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Leung LWM, Akhtar Z, Elbatran AI, Bajpai A, Li A, Norman M, Kaba R, Sohal M, Zuberi Z, Gallagher MM. Effect of esophageal cooling on ablation lesion formation in the left atrium: Insights from Ablation Index data in the IMPACT trial and clinical outcomes. J Cardiovasc Electrophysiol 2022; 33:2546-2557. [PMID: 36284450 PMCID: PMC10091801 DOI: 10.1111/jce.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The IMPACT study established the role of controlled esophageal cooling in preventing esophageal thermal injury during radiofrequency (RF) ablation for atrial fibrillation (AF). The effect of esophageal cooling on ablation lesion delivery and procedural and patient outcomes had not been previously studied. The objective was to determine the effect of esophageal cooling on the formation of RF lesions, the ability to achieve procedural endpoints, and clinical outcomes. METHODS Participants in the IMPACT trial underwent AF ablation guided by Ablation Index (30 W at 350-400 AI posteriorly, 40 W at ≥450 AI anteriorly). A blinded 1:1 randomization assigned patients to the use of the ensoETM® device to keep esophageal temperature at 4°C during ablation or standard practice using a single-sensor temperature probe. Ablation parameters and clinical outcomes were analyzed. RESULTS Procedural data from 188 patients were analyzed. Procedure and fluoroscopy times were similar, and all pulmonary veins were isolated. First-pass pulmonary vein isolation and reconnection at the end of the waiting period were similar in both randomized groups (51/64 vs. 51/68; p = 0.54 and 5/64 vs. 7/68; p = 0.76, respectively). Posterior wall isolation was also similar: 24/33 versus 27/38; p = 0.88. Ablation effect on tissue, measured in impedance drop, was no different between the two randomized groups: 8.6Ω (IQR: 6-11.8) versus 8.76Ω (IQR: 6-12.2; p = 0.25). Arrhythmia recurrence was similar after 12 months (21.1% vs. 24.1%; 95% CI: 0.38-1.84; HR: 0.83; p = 0.66). CONCLUSIONS Esophageal cooling has been shown to be effective in reducing ablation-related thermal injury during RF ablation. This protection does not compromise standard procedural endpoints or clinical success at 12 months.
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Affiliation(s)
- Lisa W M Leung
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Zaki Akhtar
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ahmed I Elbatran
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK.,Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abhay Bajpai
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Anthony Li
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mark Norman
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Riyaz Kaba
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Manav Sohal
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
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- Department of Cardiology, St. George's Hospital NHS Foundation Trust, St. George's Hospital, London, UK
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Ablation of Atrioventricular Nodal Re-Entrant Tachycardia Combining Irrigated Flexible-Tip Catheters and Three-Dimensional Electroanatomic Mapping: Long-Term Outcomes. J Cardiovasc Dev Dis 2021; 8:jcdd8060061. [PMID: 34070511 PMCID: PMC8229404 DOI: 10.3390/jcdd8060061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Transcatheter ablation is the standasrd treatment for atrioventricular nodal re-entrant tachycardia (AVNRT). However, different techniques are available. Data about the use of irrigated flexible-tip catheters and three-dimensional electroanatomical mapping (3D EAM) for AVNRT ablation are scant. The aim of this study was to evaluate in long-term follow-up efficacy and safety of a novel approach for AVNRT treatment. Methods: This is a cohort single arm study with long-term follow-up. Patients with AVNRT were treated with catheter ablation by means of irrigated flexible-tip catheters combined with 3D EAM. Results: One-hundred-and-fifty patients were enrolled and followed-up for a median of 38 months (minimum 12, maximum 74). Acute procedural success rate was 96.7% (145/150 patients). During follow-up, 11 patients had arrhythmia recurrences (7.3%). No patient developed atrioventricular conduction block with need for pacemaker implantation (0%). Fourteen patients died during follow-up (9.3%). Conclusions: Acute procedural success and long-term follow-up show that AVNRT could be safely and effectively treated with irrigated flexible-tip catheters and 3D EAM.
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Catheter ablation of focal atrial tachycardia in children using three-dimensional electroanatomic mapping system: a 6-year single-centre experience. Cardiol Young 2021; 31:744-750. [PMID: 33308335 DOI: 10.1017/s1047951120004527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study demonstrates the clinical and electrophysiological details of catheter ablation conducted in children with focal atrial tachycardia using three-dimensional electroanatomic mapping systems. PATIENTS AND METHODS Electrophysiological procedures were performed using the EnSite™ system. RESULTS Between 2014 and 2020, 60 children (median age 12.01 years [16 days-18 years]; median weight 41.5 kg [3-98 kg]) with focal atrial tachycardia and treated with catheter ablation were evaluated retrospectively. Tachycardia-induced cardiomyopathy was developed in 15 patients (25%). Most of the focal atrial tachycardia foci were right-sided (75%), and more than one focus was found in four patients. Radiofrequency ablation was performed in 47 patients (irrigated radiofrequency ablation in seven cases), cryoablation in 9, and radiofrequency ablation and cryoablation in the same session in 4 patients. The median procedural time was 163.5 minutes (82-473 minutes). Fluoroscopy was used in 29 of (48.3%) patients (especially for left-side substrate) with a mean time of 8.6 ± 6.2 minutes. The acute success rate was 95%. The procedure failed in three patients, and recurrence was observed in 3.5% of patients (2/57) during a median follow-up of 17 months (2-69 months). The second ablation was performed in four cases, of which three were successful. Overall success rate was 96.6% with no major complications observed, except in one patient with minimal pericardial effusion. CONCLUSION Catheter ablation seems to be an effective and safe treatment in focal atrial tachycardia. Electroanatomic mapping system can facilitate the ablation procedure and minimise radiation exposure.
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Soucek F, Caluori G, Lehar F, Jez J, Pesl M, Wolf J, Wojtaszczyk A, Belaskova S, Starek Z. Bipolar ablation with contact force-sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation. J Cardiovasc Electrophysiol 2020; 31:1128-1136. [PMID: 32083360 DOI: 10.1111/jce.14407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Despite technical progress, ventricular tachycardia (VT) recurrence after unipolar ablation remains relatively high (12%-47%). Bipolar ablation has been proposed as an appealing solution that may overcome limitations associated with unipolar ablation settings. We designed an animal study to compare bipolar (BPA) vs sequential unipolar ablation (UPA) using contact force-sensing technology on both ablation catheters. METHODS Twenty large white female pigs (6-months-old, 50-60 kg) underwent multiple RF ablations (30 W, 60 seconds, 30 mL/min irrigation) on the ventricular myocardium from the epicardial and endocardial sides. The hearts were fixed and scanned with high-resolution cardiac magnetic resonance imaging. Thermal lesions were located and characterized in volume, depth, width, and transmurality. RESULTS Lesion volume was calculated as the sum of epicardial or endocardial conjoined/isolated lesions at one location. Linear dimensions (width and depth) were measured twice for each location, on the endocardial and epicardial side. We evaluated 35 lesions across the intraventricular septum (UPA, N = 17 vs BPA, N = 18). No difference in volume, linear dimensions or impedance drop was observed in this area between UPA and BPA. However, BPA required half RF time and showed an increased transmurality trend. We then analyzed 73 lesions from the endocardial side (UPA, N = 35 vs BPA, N = 38) and 50 from the epicardial side (UPA, N = 11 vs BPA N = 39) of the ventricular free walls. Lesion transmurality was markedly improved by BPA (P = .030, odds ratio, 23.73 [4.71,31.96]). Ventricular BPA lesions were significantly deeper on the epicardial side (P < .0001) and endocardial side (P = .015). CONCLUSION Bipolar ablation is more likely to create transmural and epicardial lesions in the ventricle wall. Half the time is needed for the creation of comparably deep and large lesions.
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Affiliation(s)
- Filip Soucek
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Guido Caluori
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,Nanobiotechnology, CEITEC, Masaryk University, Brno, Czech Republic
| | - Frantisek Lehar
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Jiri Jez
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Martin Pesl
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Wolf
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Adam Wojtaszczyk
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Silvie Belaskova
- Biostatistics, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Zdenek Starek
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
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Pollet M, Jenny B, Mehta A, Howard A, Mathuria N. Ablation of Refractory Papillary Muscle Ventricular Tachycardia Warranting Multiple Adjunctive Ablation Techniques: A Combined Approach for Success. J Innov Card Rhythm Manag 2020; 11:3997-4003. [PMID: 32368372 PMCID: PMC7192147 DOI: 10.19102/icrm.2020.110206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/15/2019] [Indexed: 12/30/2022] Open
Abstract
A 27-year-old male presented to our institution with recurrent unifocal premature ventricular contraction/nonsustained ventricular tachycardia (VT) with associated cardiomyopathy. The patient had undergone three prior ablation procedures with continued arrhythmia. Mapping led to identification of the VT arising from the basal aspect of the left ventricular anterolateral papillary muscle. Conventional ablation techniques were unsuccessful. We incorporated adjunctive ablation techniques in this case that ultimately led to a successful outcome. The present discussion covers the roles of intracardiac echocardiography, induced apnea, and low-ionic irrigation.
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Affiliation(s)
- Mark Pollet
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Ben Jenny
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Adwait Mehta
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Austin Howard
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Nilesh Mathuria
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
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Beiert T, Schrickel JW. [Catheter ablation of cardiac arrhythmias : Forms of energy and biophysical principles]. Herzschrittmacherther Elektrophysiol 2019; 30:330-335. [PMID: 31696309 DOI: 10.1007/s00399-019-00650-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/11/2019] [Indexed: 12/16/2022]
Abstract
Catheter ablation of cardiac arrhythmias has evolved over the years and has become a cornerstone in the modern treatment of various supraventricular and ventricular arrhythmias. The goal of ablation is to permanently damage myocardium that is critically involved in the individual arrhythmia mechanism. Different catheters and forms of energy are available. Radiofrequency (RF) ablation is most common. Application of an alternating current at the catheter tip induces heating of tissue and, thus, leads to ablation of a targeted arrhythmogenic substrate. High temperatures (>70 °C at the catheter tip and >95 °C within the tissue) bear the risk of coagulum formation and steam pops and should be avoided, which limits power application. The evolution of irrigated RF ablation catheters enables the transfer of more power to the tissue and thereby increases the dimensions of the lesions. Cryoablation represents a valuable alternative. Cooling of tissue to -80 °C causes the intra- and extracellular formation of ice crystals, finally resulting in a dense circumscribed scar. The cryomapping procedure grants improved surveillance of the safety of ablation. Cryoenergy is very popular for pulmonary vein isolation (PVI) using the cryoballoon. In addition to the laser balloon that is established for PVI, ultrasound, microwaves, and stereotactic irradiation complete the arsenal.
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Affiliation(s)
- Thomas Beiert
- Medizinische Klinik und Poliklinik II, Sektion Elektrophysiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Jan W Schrickel
- Medizinische Klinik und Poliklinik II, Sektion Elektrophysiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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10
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A Review of the Use of Cryoballoon Ablation for the Treatment of Persistent Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Aequanimitas-The first thought before a long ablation procedure. Heart Rhythm 2019; 16:871-872. [PMID: 30611885 DOI: 10.1016/j.hrthm.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Indexed: 11/21/2022]
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12
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Nguyen DT, Gerstenfeld EP, Tzou WS, Jurgens PT, Zheng L, Schuller J, Zipse M, Sauer WH. Radiofrequency Ablation Using an Open Irrigated Electrode Cooled With Half-Normal Saline. JACC Clin Electrophysiol 2017; 3:1103-1110. [PMID: 29759492 DOI: 10.1016/j.jacep.2017.03.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/11/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluated the use of half-normal saline (HNS) as the radiofrequency ablation (RFA) cooling irrigant. BACKGROUND Some instances of ventricular arrhythmia may originate deep within myocardium and can be refractory to standard ablation using open irrigated RFA. Recent data suggest that deeper ablation lesions can be created by decreasing the irrigant ionic concentration delivered through open irrigated RFA than by using normal saline (NS). METHODS Bovine myocardium was placed in a circulating saline bath. Two RFA catheters were oriented across from each other, with myocardium in between. Sequential unipolar HNS-irrigated RFA was performed and compared to bipolar ablation by using NS or HNS. Unipolar HNS ablation of the ventricles in a porcine model was performed and compared to ablation using NS. RESULTS Sequential ex vivo unipolar RFA with HNS produced larger lesions than sequential unipolar RFA with NS and produced lesions of similar size to those created with bipolar RFA using NS. Ex vivo bipolar RFA using HNS created the largest lesions. In vivo unipolar HNS ablation in porcine endocardium created larger lesion volumes, 152.9 ± 29.2 μl, compared to 94.7 ± 33.4 μl for unipolar ablation using NS. CONCLUSIONS By decreasing ionic concentration and charge density in RFA using HNS instead of NS irrigant, larger ablation lesions can be created and are similar in size to lesions created using bipolar ablation. This may be a useful ablation strategy for deep myocardial circuits refractory to standard ablation. Further studies are needed to evaluate this novel RFA strategy.
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Affiliation(s)
- Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California
| | - Wendy S Tzou
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Paul T Jurgens
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Joseph Schuller
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Matthew Zipse
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
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13
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Clinical and biophysical evaluation of variable bipolar configurations during radiofrequency ablation for treatment of ventricular arrhythmias. Heart Rhythm 2016; 13:2161-2171. [DOI: 10.1016/j.hrthm.2016.07.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Indexed: 11/23/2022]
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14
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Michaud GF, Kumar S. Eliminating Coagulum Formation With Charge Delivery During Radiofrequency Ablation: Negative May Be a Positive! JACC Clin Electrophysiol 2016; 2:242-245. [PMID: 29766877 DOI: 10.1016/j.jacep.2016.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Gregory F Michaud
- Arrythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Saurabh Kumar
- Arrythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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15
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Giedrimas E, Goldberger JJ. Catheter ablation for supraventricular tachycardias: contemporary issues. Future Cardiol 2014; 9:581-96. [PMID: 23834697 DOI: 10.2217/fca.13.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The treatment of cardiac arrhythmias has evolved significantly over the last 30 years. Understanding of arrhythmia mechanisms has led to pharmacologic therapies, surgical interventions and the widely used percutaneous catheter ablation techniques. The focus of this review is centered on the current catheter ablation therapies available for supraventricular tachycardia. We will discuss current management strategies including challenges when considering catheter ablation therapy for management of supraventricular tachycardias: atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia utilizing an accessory pathway, atrial tachycardia and atrial flutter. Selected contemporary issues related to supraventricular tachycardia physiology, ablation approaches and ablation outcomes and complications will be discussed. Future goals for electrophysiologists are to continue to improve procedural safety and efficiency, while maintaining the impressive success rates that have been achieved.
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Affiliation(s)
- Evaldas Giedrimas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg 8-503E, Chicago, IL 60611, USA
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