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Toba M, Nasu T, Nekomiya N, Makino T, Yokoshiki H. Bipolar radiofrequency ablation for re-entrant ventricular tachycardia of right bundle branch block and left bundle branch block morphologies with the common slow conduction zone at the left ventricular summit: a case report. Eur Heart J Case Rep 2024; 8:ytae191. [PMID: 38690559 PMCID: PMC11060111 DOI: 10.1093/ehjcr/ytae191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Background The left ventricular (LV) summit has anatomical limitations, so the detailed mapping is difficult. Therefore, the mechanism of ventricular tachycardia (VT) originating from the LV summit is not well understood. Case summary A 70-year-old man had VTs with right bundle branch block (VT1 and VT3) and left bundle branch block (VT2) morphologies originating from the left ventricular summit (LV summit). During the VT2 and VT3, fragmented potentials, which occurred earlier than the QRS onset, were recorded from bipolar electrodes of a catheter at the anterior intraventricular vein (AIV). By pacing from right ventricular apex, constant and progressive fusion were observed. During the entrainment pacing, the fragmented potentials in the AIV catheter were activated orthodromically and those in the His bundle were activated antidromically. In addition, there were two components of the ventricular electrogram at the LV summit area with the interval of more than 100 ms during the VTs. We performed bipolar radiofrequency ablation between the LV endocardium and AIV, and the VTs became non-inducible. Discussion Non-sustained VT/premature ventricular contraction originating from LV summit is generally considered to occur due to abnormal automaticity or triggered activity. In contrast, using entrainment technique, we demonstrated that the VTs with multiple morphologies were sustained with a re-entrant mechanism. Fragmentated potentials recorded in the AIV catheter were activated orthodromically with the entrainment pacing, indicating the slowly conducting isthmus. The intramural VT substrate was also suggested with a prolonged conduction time between the two ventricular components during the VTs.
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Affiliation(s)
- Masahiro Toba
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
| | - Toshihiro Nasu
- Division of Medical Engineering Center, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuyoshi Nekomiya
- Division of Medical Engineering Center, Sapporo City General Hospital, Sapporo, Japan
| | - Takao Makino
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
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Derejko P, Janus I, Kułakowski P, Kuśnierz J, Baran J, Hangiel U, Proszek J, Frydrychowski P, Michałek M, Noszczyk-Nowak A. Bipolar endo-epicardial RF ablation: Animal feasibility study. Heart Rhythm 2024:S1547-5271(24)00126-7. [PMID: 38336196 DOI: 10.1016/j.hrthm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Bipolar radiofrequency ablation (B-RFA) is a method used to treat the arrhythmia substrate resistant to unipolar ablation. Few studies have addressed endo-epicardial B-RFA. OBJECTIVE The aim of the study was to evaluate chronic lesions resulting from endo-epicardial B-RFA and to determine optimal settings for such procedures in an animal model. METHODS In 7 pigs, up to 5 radiofrequency applications per animal were performed with 2 electrodes placed on both sides of the left ventricular free wall. Current was delivered for 60 seconds by a generator dedicated for B-RFA with power settings of 25, 30, 35, 40, and 50 W. RESULTS At 12 weeks after ablation, 31 lesions were assessed. Their maximal cross-sectional area ranged from 7.2 to 68 mm2 and correlated with total power delivered (r = 0.53), with temperature increment at the endocardial catheter (r = 0.65), and inversely with temperature decrement at the epicardial catheter (r = 0.54). For power values between 30 and 40 W, the lesion area did not differ significantly (P = .92). Lesion depth ranged from 1.9 to 11 mm and correlated with impedance decrement (r = 0.5). Lesions were transmural in 8 cases. Lesion depth/wall thickness ratio was on average 0.6 ± 0.3, with the smallest value for 25 W (0.5 ± 0.3) and the largest for 50 W (0.8 ± 0.3). Steam pops occurred at a power range of 30-50 W, with an incidence of 1 in 5 applications, with 1 case of fatal tamponade at 40 W. Impedance decrement, endocardial catheter temperature increment, and endocardial electrogram amplitude decrement were greater during applications with steam pops. CONCLUSION Chronic lesions resulting from endo-epicardial B-RFA appear smaller and less often transmural compared with acute lesions described in the literature. The incidence of steam pops during endo-epicardial B-RFA is relatively high even at low powers.
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Affiliation(s)
- Paweł Derejko
- Department of Cardiology, Medicover Hospital, Warsaw, Poland; Department of Cardiac Arrhythmias, National Institute of Cardiology, Warsaw, Poland.
| | - Izabela Janus
- Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - Piotr Kułakowski
- Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Jacek Kuśnierz
- Department of Cardiology, Medicover Hospital, Warsaw, Poland
| | - Jakub Baran
- Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | | | | | - Piotr Frydrychowski
- Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - Marcin Michałek
- Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
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Maher TR, Raza AS, Tapias C, Garcia F, Reynolds MR, Chaudry GM, Saenz LC, Valderrábano M, d'Avila A. Ventricular septal defect as a complication of bipolar radiofrequency ablation for ventricular tachycardia. Heart Rhythm 2024:S1547-5271(24)00106-1. [PMID: 38309450 DOI: 10.1016/j.hrthm.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Timothy R Maher
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Adnan S Raza
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Carlos Tapias
- Internacional Arrhythmia Center at Cardioinfantil Foundation, Bogota, Colombia
| | - Fermin Garcia
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew R Reynolds
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - G Muqtada Chaudry
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Luis C Saenz
- Internacional Arrhythmia Center at Cardioinfantil Foundation, Bogota, Colombia
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Andre d'Avila
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Kuniewicz M, Budnicka K, Dusza M, Jakob N, Cholewa N, Defonseka R, Gosnell M, Wadhwa T, Walocha J, Dobrzynski H, Hołda M. Gross anatomic relationship between the human left atrial appendage and the left ventricular summit region: implications for catheter ablation of ventricular arrhythmias originating from the left ventricular summit. J Interv Card Electrophysiol 2023; 66:301-310. [PMID: 35262858 DOI: 10.1007/s10840-022-01172-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The left ventricular summit (LVS) is a source of difficult-to-treat arrhythmias because of anatomical limitations. The aim of this study was to perform detailed research of the left atrial appendage (LAA) anatomy of cadaveric hearts to analyze their complex anatomy and coverage of the LVS. METHODS AND RESULTS Eighty human formalin fixed hearts (mean age 44.4 ± 15.5, 27.5% females) were investigated. Each LAA size, type, and its relationship to the LVS were analyzed, as well as possible access sites for mapping/ablating electrode. Four types of LAA were observed over two LVS sites that are either accessible or not. The highest coverage over an inaccessible LVS area was observed in the Broccoli type, followed by the Windsock then the Chicken Wing and finally the Cactus types; over the accessible area of the LVS was observed in the Windsock, then in the Chicken Wing, then in the Cactus, and finally in the Broccoli types. The attainable coverage for electrode access is diminished from 25 to 65% because of the complex pectinate muscles and sharp angles. The highest density of the LAA floor made by pectinate muscles can be found in the Broccoli type (p < 0.005), while the Chicken Wing had the highest number of paper-thin-like pouches. CONCLUSIONS The LAA appears to be a promising entry for ablation-qualified patients with the LV summit originate arrhythmias. The complex internal structure of the LAA may complicate ablation procedures. More prominent appendages are promising in more extensive mapping areas over the LVS.
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Affiliation(s)
- M Kuniewicz
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland. .,Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.
| | - K Budnicka
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - M Dusza
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - N Jakob
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - N Cholewa
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - R Defonseka
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - M Gosnell
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - T Wadhwa
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - J Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland
| | - H Dobrzynski
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - M Hołda
- Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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5
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Abstract
Challenging anatomic and morphologic conditions of the left ventricular (LV) summit architecture and its surrounding sites may prevent sufficient heating of the targeted area during standard radiofrequency catheter ablation. Bipolar ablation can result in higher likelihood of efficacy for ablation of LV summit arrhythmias from inaccessible regions and increase the chance of achieving a transmural lesion. In this review, the authors describe the present approaches for bipolar ablation of the LV summit arrhythmias refractory to standard approaches.
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Affiliation(s)
- Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Anny Jagiellonki 17, Rzeszów 35-623, Poland.
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Stojadinović P, Wichterle D, Peichl P, Štiavnický P, Čihák R, Kautzner J. Retrograde coronary venous ethanol ablation of ventricular tachycardia in a patient after aortic valve replacement and failed both radiofrequency ablation and stereotactic radiotherapy. HeartRhythm Case Rep 2023; 9:2-5. [PMID: 36685688 DOI: 10.1016/j.hrcr.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Kany S, Alken FA, Schleberger R, Baran J, Luik A, Haas A, Ene E, Deneke T, Dinshaw L, Rillig A, Metzner A, Reissmann B, Makimoto H, Reents T, Popa MA, Deisenhofer I, Piotrowski R, Kulakowski P, Kirchhof P, Scherschel K, Meyer C. Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach. Europace 2022; 24:959-969. [PMID: 34922350 PMCID: PMC9282917 DOI: 10.1093/europace/euab304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/18/2021] [Indexed: 12/29/2022] Open
Abstract
AIMS Bipolar radiofrequency ablation (B-RFA) has been reported as a bail-out strategy for the treatment of therapy refractory ventricular arrhythmias (VA). Currently, existing setups have not been standardized for B-RFA, while the impact of conventional B-RFA approaches on lesion formation remains unclear. METHODS AND RESULTS (i) In a multicentre observational study, patients undergoing B-RFA for previously therapy-refractory VA using a dedicated B-RFA setup were retrospectively analysed. (ii) Additionally, in an ex vivo model lesion formation during B-RFA was evaluated using porcine hearts. In a total of 26 procedures (24 patients), acute success was achieved in all 14 ventricular tachycardia (VT) procedures and 7/12 procedures with premature ventricular contractions (PVC), with major complications occurring in 1 procedure (atrioventricular block). During a median follow-up of 211 days in 21 patients, 6/11 patients (VT) and 5/10 patients (PVC) remained arrhythmia-free. Lesion formation in the ex vivo model during energy titration from 30 to 50 W led to similar lesion volumes compared with initial high-power 50 W B-RFA. Lesion size significantly increased when combining sequential unipolar and B-RFA (1429 mm3 vs. titration 501 mm3 vs. B-RFA 50 W 423 mm3, P < 0.001), an approach used in overall 58% of procedures and more frequently applied in procedures without VA recurrence (92% vs. 36%, P = 0.009). Adipose tissue severely limited lesion formation during B-RFA. CONCLUSION Using a dedicated device for B-RFA for therapy-refractory VA appears feasible and safe. While some patients need repeat ablation, success rates were encouraging. Sequential unipolar and B-RFA may be favourable for lesion formation.
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Affiliation(s)
- Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Fares Alexander Alken
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Kirchfeldstr. 40, 40217 Düsseldorf, Germany
| | - Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Armin Luik
- Department of Medicine IV, Hospital Karlsruhe GmbH, Karlsruhe, Germany
| | - Annika Haas
- Department of Medicine IV, Hospital Karlsruhe GmbH, Karlsruhe, Germany
| | - Elena Ene
- Division of Cardiology II, Röhn Hospital, Campus Bad Neustadt, Bad Neustadt/Saale, Germany
| | - Thomas Deneke
- Division of Cardiology II, Röhn Hospital, Campus Bad Neustadt, Bad Neustadt/Saale, Germany
| | - L Dinshaw
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Hisaki Makimoto
- Division of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tilko Reents
- Division of Cardiology, German Heart Center Munich, Munich, Germany
| | | | | | - Roman Piotrowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kulakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Katharina Scherschel
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Kirchfeldstr. 40, 40217 Düsseldorf, Germany
- Institute for Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Meyer
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Kirchfeldstr. 40, 40217 Düsseldorf, Germany
- Institute for Neural and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Garg L, Pothineni NVK, Arroyo A, Rodriguez D, Garcia FC, Hyman MC, Kumareswaran R, Arkles JS, Schaller RD, Supple GE, Frankel DS, Riley MP, Nazarian S, Lin D, Dixit S, Callans DJ, Zado ES, Marchlinski FE, Saenz LC, Santangeli P. Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes. Heart Rhythm 2021; 18:1491-1499. [PMID: 33984525 DOI: 10.1016/j.hrthm.2021.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interatrial septal tachycardias (IAS-ATs) following atrial fibrillation (AF) ablation or cardiac surgery are rare, and their management is challenging. OBJECTIVE The purpose of this study was to investigate the electrophysiological features and outcomes associated with catheter ablation of IAS-AT. METHODS We screened 338 patients undergoing catheter ablation of ATs following AF ablation or cardiac surgery. Diagnosis of IAS-AT was based on activation mapping and analysis of response to atrial overdrive pacing. RESULTS Twenty-nine patients (9%) had IAS-AT (cycle length [CL] 311 ± 104 ms); 16 (55%) had prior AF ablation procedures (median 3; range 1-5), 3 (10%) had prior surgical maze, and 12 (41%) had prior cardiac surgery (including atrial septal defect surgical repair in 5 and left atrial myxoma resection in 1). IAS substrate abnormalities were documented in all patients. Activation mapping always demonstrated a diffuse early IAS breakout with centrifugal biatrial activation, and atrial overdrive pacing showed a good postpacing interval (equal or within 25 ms of the AT CL) only at 1 or 2 anatomically opposite IAS sites in all cases. Ablation was acutely successful in 27 patients (93%) (from only the right IAS in 2, only the left IAS in 9, both IAS sides with sequential ablation in 13, and both IAS sides with bipolar ablation in 3). After median follow-up of 15 (6-52) months, 17 patients (59%) remained free from recurrent arrhythmias. CONCLUSION IAS-ATs are rare and typically occur in patients with evidence of IAS substrate abnormalities and prior cardiac surgery. Catheter ablation can be challenging and may require sequential unipolar ablation or bipolar ablation.
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Affiliation(s)
- Lohit Garg
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alonso Arroyo
- Electrophysiology Section, Fundación Cardio Infantil, Bogota, Colombia
| | - Diego Rodriguez
- Electrophysiology Section, Fundación Cardio Infantil, Bogota, Colombia
| | - Fermin C Garcia
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Arkles
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica S Zado
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luis C Saenz
- Electrophysiology Section, Fundación Cardio Infantil, Bogota, Colombia
| | - Pasquale Santangeli
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Matteucci F, Maesen B, De Asmundis C, Bidar E, Micali L, Parise G, Maessen JG, La Meir M, Gelsomino S. Biparietal bidirectional bipolar radiofrequency in hybrid cardiac ablation: an in vitro evaluation. Interact Cardiovasc Thorac Surg 2021; 33:34-42. [PMID: 33611536 DOI: 10.1093/icvts/ivab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/21/2020] [Accepted: 01/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the lesion size and depth of radiofrequency (RF) ablation in a simultaneous biparietal bidirectional bipolar (SBB) approach, compared to a simultaneous and staged unipolar and uniparietal bipolar setup [simultaneous uniparietal bipolar (SiUB) and staged uniparietal bipolar (StUB), respectively]. METHODS Fresh left atrial porcine tissue was mounted into the ABLA-BOX simulator. Different ablation approaches were tested: (i) SBB: a concept consisting of SBB endo-epicardial ablation, (ii) SiUB: simultaneous epicardial uniparietal bipolar and endocardial unipolar ablation and (iii) StUB: staged epicardial uniparietal bipolar and endocardial unipolar ablation. In the StUB setup, a 1-h interval between the epi-endo ablation was respected. RESULTS Transmural lesions were present in 90% of the bipolar biparietal ablations, yet no full transmurality was observed in the simultaneous nor in the staged unipolar with uniparietal bipolar ablation group. In SBB, the area and volume of the ablation lesions were smaller (523.33 mm2/mm and 52.33 mm3/mm, respectively) than in SiUB (588.17 mm2/mm and 58.81 mm3/mm, respectively) and StUB (583.76 mm2/mm and 58.37 mm3/mm, P = 0.044). Also, in SBB, the overall, epicardial and endocardial maximum diameters of the lesions (1.59, 1.57 and 1.52 mm; respectively) were smaller than in SiUB (2.38, 2.26 and 2.33 mm; respectively) and in StUB (2.36, 2.28 and 2.14 mm; respectively, all P < 0.001). CONCLUSIONS Although bipolar biparietal bidirectional RF ablation results in smaller lesions than uniparietal bipolar and unipolar ablation, their capacity to penetrate the tissue is much higher. Moreover, in uniparietal RF applications, the energy spreads in the superficial layers of the tissue but fails to penetrate. Therefore, the degree of transmurality is much higher when using such a 'truly bipolar' ablation approach.
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Affiliation(s)
- Francesco Matteucci
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Bart Maesen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Carlo De Asmundis
- Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Elham Bidar
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Linda Micali
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Gianmarco Parise
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Jos G Maessen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Mark La Meir
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands.,Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands.,Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
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10
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John M, Rook A, Post A, Mersman A, Allen W, Schramm C, Razavi M. Bipolar ablation's unique paradigm: Duration and power as respectively distinct primary determinants of transmurality and steam pop formation. Heart Rhythm O2 2020; 1:290-296. [PMID: 34113883 PMCID: PMC8183883 DOI: 10.1016/j.hroo.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/16/2020] [Indexed: 01/24/2023] Open
Abstract
Background Bipolar radiofrequency (RF) ablation strategies are increasingly used, mainly to target deep myocardial reentrant circuits responsible for ventricular tachycardia that cannot be extinguished with traditional unipolar RF ablation. Because this strategy is novel, factors that affect lesion geometry and steam pop formation require further investigation. Objective To assess the effect of contact force, power, and time on the resulting lesion geometry and the risk of steam pop formation during bipolar RF ablation of thick myocardial tissue. Methods A custom ex vivo bipolar ablation model was used to assess lesion formation. A combination of parallel and perpendicular configurations of ablation catheters was used to create lesions by varying force (20g, 30g, or 40g), power (30 or 40 W), and time (20, 30, 45, or 60 seconds). Lesion dimensions and the incidence of steam pops were recorded and then analyzed with binary logistic regression and multiple linear regression. Results In bipolar ablation, lesion transmurality was most affected by the amount of time RF energy was applied. Durations longer than 20 seconds resulted in lesions deeper than half the tissue thickness. Steam pop formation was more frequent in thinner tissue, at longer ablation times, and at higher powers. Conclusion The parameters assessed in this ex vivo model could be used as guidelines for future in vivo work and clinical evaluation of interventricular septal bipolar ablation.
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Affiliation(s)
- Mathews John
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Ashley Rook
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Allison Post
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | | | | | | | - Mehdi Razavi
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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12
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Enriquez A, Neira V, Bakker D, Baley J, Bisleri G, Baranchuk A, Redfearn D. Bipolar ablation with half normal saline for deep intramural outflow tract premature ventricular contraction. HeartRhythm Case Rep 2019; 5:436-439. [PMID: 31453098 PMCID: PMC6701005 DOI: 10.1016/j.hrcr.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Jason Baley
- Division of Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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Al-Hadithi ABAK, Khakpour H, Cruz D, Boyle NG, Shivkumar K, Bradfield JS. Incessant intraseptal ventricular tachycardia ablated utilizing extracorporeal membrane oxygenation and bipolar ablation. HeartRhythm Case Rep 2018; 4:557-560. [PMID: 30581730 PMCID: PMC6301887 DOI: 10.1016/j.hrcr.2018.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Ali B A K Al-Hadithi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Houman Khakpour
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Daniel Cruz
- UCLA Cardiomyopathy Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
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Sauer PJ, Kunkel MJ, Nguyen DT, Davies A, Lane C, Tzou WS. Successful ablation of ventricular tachycardia arising from a midmyocardial septal outflow tract site utilizing a simplified bipolar ablation setup. HeartRhythm Case Rep 2018; 5:105-108. [PMID: 30820408 PMCID: PMC6379518 DOI: 10.1016/j.hrcr.2018.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Peter J Sauer
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Megan J Kunkel
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Austin Davies
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Curtis Lane
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Wendy S Tzou
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
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15
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Kim Y, Audigier C, Ziegle J, Friebe M, Boctor EM. Ultrasound thermal monitoring with an external ultrasound source for customized bipolar RF ablation shapes. Int J Comput Assist Radiol Surg 2018; 13:815-826. [PMID: 29619610 PMCID: PMC6573022 DOI: 10.1007/s11548-018-1744-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Thermotherapy is a clinical procedure which delivers thermal energy to a target, and it has been applied for various medical treatments. Temperature monitoring during thermotherapy is important to achieve precise and reproducible results. Medical ultrasound can be used for thermal monitoring and is an attractive medical imaging modality due to its advantages including non-ionizing radiation, cost-effectiveness and portability. We propose an ultrasound thermal monitoring method using a speed-of-sound tomographic approach coupled with a biophysical heat diffusion model. METHODS We implement an ultrasound thermometry approach using an external ultrasound source. We reconstruct the speed-of-sound images using time-of-flight information from the external ultrasound source and convert the speed-of-sound information into temperature by using the a priori knowledge brought by a biophysical heat diffusion model. RESULTS Customized treatment shapes can be created using switching channels of radio frequency bipolar needle electrodes. Simulations of various ablation lesion shapes in the temperature range of 21-59 [Formula: see text]C are performed to study the feasibility of the proposed method. We also evaluated our method with ex vivo porcine liver experiments, in which we generated temperature images between 22 and 45 [Formula: see text]C. CONCLUSION In this paper, we present a proof of concept showing the feasibility of our ultrasound thermal monitoring method. The proposed method could be applied to various thermotherapy procedures by only adding an ultrasound source.
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Affiliation(s)
- Younsu Kim
- Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, 21218, USA
| | - Chloé Audigier
- Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, 21218, USA
| | - Jens Ziegle
- Otto-von-Guericke University, Universitaetsplatz 2, 39106, Magdeburg, Saxony-Anhalt, Germany
| | - Michael Friebe
- Otto-von-Guericke University, Universitaetsplatz 2, 39106, Magdeburg, Saxony-Anhalt, Germany
| | - Emad M Boctor
- Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, 21218, USA.
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Kawakami H, Nagai T, Fujii A, Uetani T, Nishimura K, Inoue K, Suzuki J, Satomi K, Okura T, Higaki J, Ogimoto A. Identifying the true origin of sustained monomorphic ventricular tachycardia associated with dilated-phase hypertrophic cardiomyopathy: A case of successful catheter ablation. J Arrhythm 2015; 31:406-9. [PMID: 26702325 PMCID: PMC4672081 DOI: 10.1016/j.joa.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 12/03/2022] Open
Abstract
This case report describes sustained monomorphic ventricular tachycardia (VT) caused by a large epicardial scar, related to dilated-phase hypertrophic cardiomyopathy mimicking VT originating from the apical septum. VT resolved with epicardial catheter ablation. The exit of the VT circuit suggested that a 12-lead electrocardiogram can be remote with respect to the critical isthmus in this case. In patients with structural heart disease, it is difficult to identify the VT reentrant circuit by surface electrocardiography, which shows only the exit site. VT originating in the epicardium should be considered, even if the suspected origin is another ventricular site.
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Affiliation(s)
- Hiroshi Kawakami
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takayuki Nagai
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Akira Fujii
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Teruyoshi Uetani
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kazuhisa Nishimura
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Katsuji Inoue
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Jun Suzuki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takafumi Okura
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Jitsuo Higaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Akiyoshi Ogimoto
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Berte B, Derval N, Sacher F, Yamashita S, Haïssaguerre M, Jaïs P. A case of incessant VT from an intramural septal focus: Ethanol or bipolar ablation? HeartRhythm Case Rep 2015; 1:89-94. [PMID: 28491520 PMCID: PMC5418617 DOI: 10.1016/j.hrcr.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | - Pïerre Jaïs
- Address reprint requests and correspondence: Dr Pierre Jaïs, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute, Bordeaux-Pessac 33604, France
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Li M, Chen Y, Luo Z, Zhang W, He B. Experimental observation of vitro pigs' hearts with bipolar radiofrequency ablation. Int J Clin Exp Med 2013; 6:614-620. [PMID: 24040468 PMCID: PMC3762615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
Bipolar ablation is an innovative direction of catheter ablation technology. The aim of this study was to investigate the damaged area of bipolar radiofrequency ablation in vitro pigs' hearts under different conditions and to evaluate the effectiveness and safety. The bipolar radiofrequency ablation was performed in vitro pigs' hearts with a 4 mm bipolar electrode under different conditions at various combinations of the parameters (Distance: from 12 mm to 17 mm; Power: 30 w or 40 w; Time: from 20 s to 90 s; Temperature: 45°C or 60°C; Saline Perfusion: 0 ml/h, 1000 ml/h or 1500 ml/h). We measured the length, width, depth, connection rate and blasting rate of the connective ablation lesion and then evaluated the effectiveness and safety of connective ablation lesion. Numerical analysis showed that there was a positive correlation between the time, temperature and the length, depth, connection rate, blasting rate. There was a negative correlation between the power, perfusion and the depth, while other indexes were positively correlated with the power, perfusion. Distance and length were positively correlated, while other indexes were negatively correlated with the distance. Regression analysis showed that the infusion was not significantly correlated with the depth, connection rate, blasting rate. The temperature was not significantly correlated with the length, connection rate. Power and depth's correlation was not significant. When the parameter combination was 12 mm, 20 s, 30 w, 60°C, 1500 ml/h, the effectiveness and safety was optimum, with the mean lesion length being 19.89 ± 3.02 mm, the depth of an average being 3.50 ± 0.63 mm, the connection rate and the blasting rate being 100% and 13.9% respectively. The bipolar ablation in vitro pigs' hearts could form the most stable continuous damage.
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Affiliation(s)
- Min Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Yingmin Chen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Zhangyuan Luo
- Jie Sheng (Shanghai) Biological Technology Co., LtdShanghai, China
| | - Wenzan Zhang
- Jie Sheng (Shanghai) Biological Technology Co., LtdShanghai, China
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
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