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Cheung CC, Gerstenfeld EP. Rethinking Ablation Indices in the Ventricle: It's About Time! JACC Clin Electrophysiol 2023; 9:1681-1683. [PMID: 37498244 DOI: 10.1016/j.jacep.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Christopher C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Section of Cardiac Electrophysiology, University of California-San Francisco, San Francisco, California, USA.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California-San Francisco, San Francisco, California, USA
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Pang N, Gao J, Zhang N, Guo M, Wang R. Cavotricuspid isthmus ablation for atrial flutter guided by contact force related parameters: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1060542. [PMID: 36684611 PMCID: PMC9853203 DOI: 10.3389/fcvm.2022.1060542] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL. Methods Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies. Results Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group (p = 0.01), while procedural time (p = 0.13) and fluoroscopy time (p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions (p = 0.0003) and greater CF of catheter-tissue (p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group (p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates (p = 0.25), recurrence rates (p = 0.92), and complication rates (p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.10). Conclusion CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
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Affiliation(s)
- Naidong Pang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Rui Wang,
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Donder A, Baena FRY. Kalman-Filter-Based, Dynamic 3-D Shape Reconstruction for Steerable Needles With Fiber Bragg Gratings in Multicore Fibers. IEEE T ROBOT 2022. [DOI: 10.1109/tro.2021.3125853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Abdulhamit Donder
- Mechatronics in Medicine Laboratory, Department of Mechanical Engineering, Imperial College London, London, U.K
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4
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Nussinovitch U, Wang P, Narayan S, Viswanathan M, Badhwar N, Zheng L, Sauer WH, Nguyen DT. Perpendicular Catheter Orientation During Papillary Muscle Ablation Results in Larger, Deeper Lesions. J Cardiovasc Electrophysiol 2022; 33:690-695. [PMID: 35133050 DOI: 10.1111/jce.15408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Ablation of papillary muscles (PM) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect optimal radiofrequency (RF) delivery. Yet, no previous study investigated the association between catheter orientation and PM lesion size. We evaluated ablation lesion characteristics with various catheter orientations relative to the PM tissue during open irrigated ablation, using a standardized, experimental setting. METHODS Viable bovine PM was positioned on a load cell in a circulating saline bath. RF ablation was performed over PM tissue at 50W, with the open irrigated catheter positioned either perpendicular or parallel to the PM surface. Applied force was 10 grams. Ablation lesions were sectioned and underwent quantitative morphometric analysis. RESULTS A catheter position oriented directly perpendicular to the PM tissue resulted in the largest ablation lesion volumes and depths compared to ablation with the catheter parallel to PM tissue (75.26±8.40 mm3 vs. 34.04±2.91 mm3 , p<0.001) and (3.33±0.18 mm vs. 2.24±0.10 mm, p<0.001), respectively. There were no significant differences in initial impedance, peak voltage, peak current, or overall decrease in impedance among groups. Parallel catheter orientation resulted in higher peak temperature (41.33±0.28°C vs. 40.28±0.24°C, p=0.003), yet, there were no steam pops in either group. CONCLUSION For PM ablation, catheter orientation perpendicular to the PM tissue achieves more effective and larger ablation lesions, with greater lesion depth. This may have implications for the chosen ventricular access approach, the type of catheter used, consideration for remote navigation, and steerable sheaths. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Udi Nussinovitch
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Paul Wang
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Sanjiv Narayan
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Mohan Viswanathan
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, Brigham and Women's Hospital, Boston, MA
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
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5
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Tschabrunn CM, Santangeli P. Maximizing papillary muscle radiofrequency ablation size: Importance of catheter orientation. J Cardiovasc Electrophysiol 2022; 33:696-697. [PMID: 35132708 DOI: 10.1111/jce.15403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cory M Tschabrunn
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Coderch-Navarro S, Berjano E, Camara O, González-Suárez A. High-power short-duration vs. standard radiofrequency cardiac ablation: comparative study based on an in-silico model. Int J Hyperthermia 2021; 38:582-592. [PMID: 33847211 DOI: 10.1080/02656736.2021.1909148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE While the standard setting during radiofrequency catheter ablation (RFCA) consists of applying low power for long times, a new setting based on high power and short duration (HPSD) has recently been suggested as safer and more effective. Our aim was to compare the electrical and thermal performance of standard vs. HPSD settings, especially to assess the effect of the catheter orientation. METHODS A 3D computational model was built based on a coupled electric-thermal-flow problem. Standard (20 W-45 s and 30 W-30 s) and HPSD settings (70 W-7 s and 90 W-4 s) were compared. Since the model only included a cardiac tissue fragment, the power values were adjusted to 80% of the clinical values (15, 23, 53 and 69 W). Three catheter-tissue orientations were considered (90°, 45° and 0°). Thermal lesions were assessed by the Arrhenius equation. Safety was assessed by checking the occurrence of steam pops (100 °C in tissue) and thrombus formation (80 °C in blood). RESULTS The computed thermal lesions were in close agreement with the experimental data in the literature, in particular with in vivo studies. HPSD created shallower and wider lesions than standard settings, especially with the catheter at 45°. Steam pops occurred earlier with HPSD, regardless of catheter orientation. CONCLUSION HPSD seems to be more effective in cases that need shallow and extensive lesions, especially when the catheter is at 0° or at 45°, as used in pulmonary vein isolation.
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Affiliation(s)
- Sergi Coderch-Navarro
- 3D Surgical Planning Lab, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Oscar Camara
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana González-Suárez
- Electrical and Electronic Engineering, National University of Ireland Galway, Ireland.,Translational Medical Device Lab, National University of Ireland, Galway, Ireland
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Dickow J, Wang S, Suzuki A, Imamura K, Lehmann HI, Parker KD, Newman LK, Monahan KH, Rettmann ME, Curley MG, Packer DL. Real-time intracardiac echocardiography validation of saline-enhanced radiofrequency needle-tip ablation: lesion characteristics and gross pathology correlation. Europace 2021; 23:1826-1836. [PMID: 33993234 DOI: 10.1093/europace/euab121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS With the implementation of saline-enhanced radiofrequency (SERF) needle-tip ablation, real-time validation of lesion formation is needed for the controllable creation of transmural lesions. The aim of the study was to analyse the ability of two-dimensional intracardiac echocardiography (2D-ICE) to guide and validate SERF ablation in real-time. METHODS AND RESULTS Fifty-six SERF energy deliveries at left ventricular sites of 11 dogs guided by 2D-ICE were analysed (power: 15-50 W; time: 25-120 s; irrigation saline: 60°C with 10 mL/min flow rate). Catheter tip/tissue orientation and lesion formation could be well detected by 2D-ICE in 49 (87.5%) energy deliveries. Gross pathology analysis confirmed excellent 2D-ICE lesion localization, the ability to detect transmural lesions (70% sensitivity, 47% specificity) and positive correlation between 2D-ICE and the corresponding gross pathology measurements of 'maximal lesion depth'; (repeated measures correlation: rrm = 0.43, P = 0.012) and 'depth at maximal lesion width' (D@MW; rrm = 0.51, P = 0.003). The median angle between SERF catheter tip and endocardium was 76° [interquartile range (IQR) 58-83°]. The more perpendicular the catheter tip/tissue orientation was the deeper D@MW (rrm = 0.32, P = 0.045). Grade 3 microbubbles on 2D-ICE during ablation, indicating inadequate catheter tip/tissue contact, was associated with smaller lesion volumes than with Grade 1 microbubbles (284.8 mm3 [IQR 151.3-343.1] vs. 2114.1 mm3 [IQR 1437.0-3026.3], P < 0.001). CONCLUSION With excellent lesion localization and a 70% detection rate of transmural lesions, 2D-ICE is well suited to validate SERF ablation lesion formation in real-time. The catheter tip/tissue angle impacts the lesion formation and through perpendicular catheter positioning, deeper intramural areas of the myocardium can be reached.
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Affiliation(s)
- Jannis Dickow
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Songyun Wang
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Atsushi Suzuki
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Kimitake Imamura
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - H Immo Lehmann
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Kay D Parker
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Laura K Newman
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Kristi H Monahan
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | - Maryam E Rettmann
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
| | | | - Douglas L Packer
- Translational Interventional Electrophysiology Laboratory, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55905, USA
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Calzolari V, De Mattia L, Basso F, Crosato M, Scalon A, Squasi PAM, Del Favero S, Cernetti C. Ablation catheter orientation: In vitro effects on lesion size and in vivo analysis during PVI for atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1554-1563. [PMID: 33111985 DOI: 10.1111/pace.14106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catheter-delivered radiofrequency (RF) lesion formation is a complex phenomenon, and few studies have explored the effect of catheter orientation on lesion size and catheter orientation behavior during pulmonary vein isolation (PVI) procedures. We evaluated the influence of catheter orientation on lesion dimensions in an in vitro experimental setting and investigated the catheter orientation behavior during PVI. METHODS AND RESULTS 72 lesions were created in vitro on a porcine heart using a contact force catheter in a parallel, oblique, and perpendicular tip to tissue orientation. The superficial lesion length (SLL) increased shifting the catheter from perpendicular to parallel orientation. The intratissue absolute maximal lesion length (AML) was greater with an oblique catheter orientation. The lesion depth (LD) and the superficial lesion width (SLW) resulted similar with any orientation. Data from 21 PVI procedures in patients with paroxysmal atrial fibrillation using the "wide antral circumferential RF ablation" (WACA) technique were retrospectively analyzed. The mean contact angle among 1130 RF lesions was 28 ± 20°. A prevalent parallel orientation was noted in the anterior WACA segments, whereas it resulted more perpendicular in the posterior segments. Significant differences in catheter orientation between the three operators were found only in few WACA segments. CONCLUSIONS In an in vitro setting, catheter orientation affects SLL and AML, but not LD and SLW. During PVI procedures, catheter orientation resulted mostly parallel to the endocardium. Catheter orientation varied among different WACA segments, but only small differences were found between three operators when considering similar WACA segments.
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Affiliation(s)
| | - Luca De Mattia
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
| | | | - Martino Crosato
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
| | | | | | | | - Carlo Cernetti
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
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9
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Calzolari V, De Mattia L, Indiani S, Crosato M, Furlanetto A, Licciardello C, Squasi PAM, Olivari Z. In Vitro Validation of the Lesion Size Index to Predict Lesion Width and Depth After Irrigated Radiofrequency Ablation in a Porcine Model. JACC Clin Electrophysiol 2017; 3:1126-1135. [PMID: 29759495 DOI: 10.1016/j.jacep.2017.08.016] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/10/2017] [Accepted: 08/31/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES In an in vitro model, the authors tested the hypotheses that: 1) lesion dimensions correlate with lesion size index (LSI); and 2) LSI could predict lesion dimensions better than power, contact force (CF), and force-time integral (FTI). BACKGROUND When performing radiofrequency (RF) catheter ablation for cardiac arrhythmias, reliable predictors of lesion quality are lacking. The LSI is a multiparametric index incorporating time, power, CF, and impedance recorded during ablation. METHODS RF lesions were created on porcine myocardial slabs by using an open-tip irrigated catheter capable of real-time monitoring of catheter-tissue CF. Initially, 3 power settings of 20, 25, and 30 W were used with a fixed CF of 10 g. A fixed power of 20 W was then set with a CF of 20 and 30 g, thereby yielding a total of 5 ablation groups. In each group, LSI values of 5, 6, 7, and 8 were targeted. Sixty RF lesions were created by using 20 ablation protocols (3 lesions for each protocol). RESULTS Lesion width and depth were not correlated with power or CF, but the results significantly correlated with FTI (p < 0.01) and LSI (p < 0.0001). Four steam pops occurred with power set at 30 W; no pops were noted with 20 or 25 W even when high LSI values were targeted. CONCLUSIONS In this in vitro model, FTI and LSI predicted RF lesion dimensions, whereas power and CF did not. The LSI predictive value was higher than that of FTI. Steam pops occurred only using high ablation power levels, regardless of the targeted LSI.
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Affiliation(s)
| | - Luca De Mattia
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
| | | | - Martino Crosato
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Alberto Furlanetto
- Department of Anatomical Pathology, Ca' Foncello Hospital, Treviso, Italy
| | | | | | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
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10
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Saygi S, Bastani H, Drca N, Insulander P, Wredlert C, Schwieler J, Jensen-Urstad M. Impact of cavotricuspid isthmus morphology in CRYO versus radiofrequency ablation of typical atrial flutter. SCAND CARDIOVASC J 2016; 51:69-73. [DOI: 10.1080/14017431.2016.1259496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Serkan Saygi
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Christer Wredlert
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Hussein AA, Oberti C, Wazni OM, Hegrenes JA, Sral JA, Lopez J, Kowalewski W, Kattar J, Kanj M, Lindsay B, Saliba W. Radiofrequency Ablation with an Enhanced-Irrigation Flexible-Tip Catheter versus a Standard-Irrigation Rigid-Tip Catheter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1151-8. [PMID: 26096454 DOI: 10.1111/pace.12676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/03/2015] [Accepted: 06/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The flexible-tip irrigated ablation catheter Cool Flex™ (St. Jude Medical, St. Paul, MN, USA) was introduced to enhance cooling of the catheter-tissue interface and to conform to endocardial surface with better contact. Little is known about the performance of such catheter design compared to the widely used rigid-tip catheters. METHODS In a thigh muscle preparation, ablation using the flexible-tip and rigid-tip catheters was performed in seven pigs across a range of ablation settings and catheter orientation. Postprocedure, the thigh muscle was stained with 2,3,5-triphenyltetrazolium-chloride injected into the femoral artery. The muscle was excised, fixed with formalin, and examined grossly. RESULTS A total of 196 lesions (95 flexible tip, 101 rigid tip) were evaluated. The flexible-tip catheter was associated with enhanced cooling of catheter-tissue interface (31.1 ± 3.3°C vs 36.3 ± 3.7°C, P = 0.0001) in both perpendicular and nonperpendicular catheter orientations. This allowed more energy delivery (37.3 ± 8.9 W vs 33.7 ± 8.1 W, P = 0.004) to targeted tissue and resulted in larger lesions (median 194.7 [interquartile range: 113.1-333.8] mm(3) vs 170.9 [88.7-261.6] mm(3) , P = 0.03) than the rigid-tip catheter with larger maximum diameter (11.1 ± 2.6 mm vs 10.3 ± 2.1 mm, P = 0.03) and larger diameter at tissue surface (10.3 ± 2.4 mm vs 9.6 ± 1.7 mm, P = 0.01). Catheter orientation during ablation affected the efficiency of rigid-tip but not the flexible-tip catheter. The use of the flexible-tip catheter was associated with significantly less char formation on tissue (none vs 5.1% with rigid tip, P = 0.009). CONCLUSION The Cool Flex™ catheter performed better than a rigid-tip catheter with enhanced cooling, larger ablation lesions, and no charring of targeted tissue.
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Affiliation(s)
- Ayman A Hussein
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carlos Oberti
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - John Lopez
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William Kowalewski
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jacqueline Kattar
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bruce Lindsay
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Walid Saliba
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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12
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Thermal expansion imaging for monitoring lesion depth using M-mode ultrasound during cardiac RF ablation: in vitro study. Int J Comput Assist Radiol Surg 2015; 10:681-93. [DOI: 10.1007/s11548-015-1203-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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13
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GUERRA JOSEM, JORGE ESTHER, RAGA SILVIA, GÁLVEZ-MONTÓN CAROLINA, ALONSO-MARTÍN CONCEPCIÓN, RODRÍGUEZ-FONT ENRIQUE, CINCA JUAN, VIÑOLAS XAVIER. Effects of Open-Irrigated Radiofrequency Ablation Catheter Design on Lesion Formation and Complications: In Vitro
Comparison of 6 Different Devices. J Cardiovasc Electrophysiol 2013; 24:1157-62. [DOI: 10.1111/jce.12175] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/07/2013] [Accepted: 04/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- JOSE M. GUERRA
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - ESTHER JORGE
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - SILVIA RAGA
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - CAROLINA GÁLVEZ-MONTÓN
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - CONCEPCIÓN ALONSO-MARTÍN
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - ENRIQUE RODRÍGUEZ-FONT
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - JUAN CINCA
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
| | - XAVIER VIÑOLAS
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Institut de Recerca HSCSP-IIB Sant Pau; Barcelona Spain
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14
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Da Costa A, Khris L, Nadrouss A, Chafiotte P, Romeyer-Bouchard C, Bisch L, Gate-Martinet A, Isaaz K. Single-centre experience with an 8-mm tip catheter for radiofrequency catheter ablation of outflow tract ventricular ectopic beats. Arch Cardiovasc Dis 2012; 105:24-32. [PMID: 22369915 DOI: 10.1016/j.acvd.2011.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 11/11/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) of outflow tract ventricular ectopic beats (OTVEBs) can be performed using a 4-mm or externally-cooled tip RFA catheter, but no data are available concerning the safety and efficacy of a large-tip (8-mm) catheter. AIMS To evaluate the feasibility of using an 8-mm tip catheter in patients with OTVEBs. METHODS In this prospective cohort study, the 8-mm tip catheter was tested in patients who were referred to our centre for RFA of symptomatic OTVEBs. RESULTS The mean age of the 16 patients recruited between September 2008 and March 2010 was 53±18 years and 56.3% were male. Mean left ventricular ejection fraction was 62±9%, mean ventricular ectopic beat width was 144±21 ms, and all patients had left bundle branch block. Fourteen patients had inferior axis QRS morphology and two had superior. The main symptoms were palpitations and pre-syncope. RFA parameters were: procedure time 94±35 min; duration of application 11±10 min; impedance 81±12 Ω; temperature 50±5 °C; and power 46±17 W. RFA succeeded in 15 over 16 patients (93.8%); and recurrence was seen in one patient after a mean follow-up time of 11±6 months. No complications were noted. CONCLUSIONS This preliminary study suggests that an 8-mm tip catheter may represent an alternative for RFA in patients with OTVEBs in whom a 4-mm tip was not successful. Larger randomized studies are therefore warranted.
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Affiliation(s)
- Antoine Da Costa
- Department of Cardiology, Jean-Monnet University, Faculty of Medicine J.-Lisfranc, Service de cardiologie, hôpital Nord, CHU de Saint-Etienne, 42055 Saint-Étienne cedex 2, France.
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15
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Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TSM, Wood MA. Echocardiography-guided interventions. J Am Soc Echocardiogr 2009; 22:213-31; quiz 316-7. [PMID: 19258174 DOI: 10.1016/j.echo.2008.12.013] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room-indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures.
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Affiliation(s)
- Frank E Silvestry
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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16
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DA COSTA ANTOINE, ROMEYER-BOUCHARD CÉCILE, JAMON YANN, BISCH LAURENCE, ISAAZ KARL. Radiofrequency Catheter Selection Based on Cavotricuspid Angiography Compared with a Control Group with an Externally Cooled-Tip Catheter: A Randomized Pilot Study. J Cardiovasc Electrophysiol 2009; 20:492-8. [DOI: 10.1111/j.1540-8167.2008.01367.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Packer DL, Johnson SB, Kolasa MW, Bunch TJ, Henz BD, Okumura Y. New generation of electro-anatomic mapping: full intracardiac ultrasound image integration. Europace 2008; 10 Suppl 3:iii35-41. [DOI: 10.1093/europace/eun231] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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EVERETT IV THOMASH, LEE KENW, WILSON EMILYE, GUERRA JOSEM, VAROSY PAULD, OLGIN JEFFREYE. Safety Profiles and Lesion Size of Different Radiofrequency Ablation Technologies: A Comparison of Large Tip, Open and Closed Irrigation Catheters. J Cardiovasc Electrophysiol 2008; 20:325-35. [DOI: 10.1111/j.1540-8167.2008.01305.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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OKUMURA YASUO, JOHNSON SUSANB, BUNCH TJARED, HENZ BENHURD, O'BRIEN CHRISTINEJ, PACKER DOUGLASL. A Systematical Analysis ofIn VivoContact Forces on Virtual Catheter Tip/Tissue Surface Contact during Cardiac Mapping and Intervention. J Cardiovasc Electrophysiol 2008; 19:632-40. [DOI: 10.1111/j.1540-8167.2008.01135.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Da Costa A, Jamon Y, Romeyer-Bouchard C, Thévenin J, Messier M, Isaaz K. Catheter selection for ablation of the cavotricuspid isthmus for treatment of typical atrial flutter. J Interv Card Electrophysiol 2007; 17:93-101. [PMID: 17333369 DOI: 10.1007/s10840-006-9064-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Accepted: 11/25/2006] [Indexed: 11/29/2022]
Abstract
Radiofrequency catheter ablation (RFA) represents the first line therapy of the cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) with a high efficacy and low secondary effects. RFA of CTI-dependent AFL can be performed by using various types of ablation catheters. Recent evaluations comparing externally cooled tip RFA (ecRFA) catheters and large-tip (8 mm) catheters have revealed that these catheters have a higher efficacy for CTI-AFL ablation compared to 4-mm catheters. The reliability of RFA catheters for AFL is variable and an optimal catheter selection may enhance the RFA effectiveness. The main goal of this article is to review the elements that improve the management of CTI RFA. Preliminary examinations of histopathologic and anatomical elements that may interfere with conventional CTI RFA are presented. Experimental studies concerning the electrobiology of large-tip and cooled-tip catheters are compared. The different catheter designs between cooled-tip and 8-mm-tip catheters are examined (size of the deflectable curve, rotation stability, and size of the distal nonsteerable catheter part) because of their critical role in CTI RFA results. A thorough review of clinical trials of each catheter is presented, and comparison of both catheters in this clinical setting is analyzed. In addition, the role of CTI morphology on AFL RF duration is underlined such as the value of right atrial angiography as an adjunct tool for CTI RFA catheter selection. Based on randomized studies, 8-mm-tip catheters seem to be more effective for ablation in case of straight angiographic isthmus morphology. On the other hand, ecRFA catheters appear to be more effective in cases of complex CTI anatomy or difficult CTI RFA. To reduce X-ray exposition and RFA application time, few studies report that CTI angiographic evaluation before RFA allows a catheter selection based on both CTI morphology and length. Moreover, preliminary data of randomized studies showed that an angiographic isthmus evaluation may predict both the effectiveness of a RFA catheter and the risk of an expensive catheter crossover.
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Affiliation(s)
- Antoine Da Costa
- Department of Cardiology, Faculty of Medicine J. Lisfranc, Jean Monnet University, Saint-Etienne Cedex 2, France.
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21
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Oh S, Kilicaslan F, Zhang Y, Wazni O, Mazgalev TN, Natale A, Marrouche NF. Avoiding Microbubbles Formation During Radiofrequency Left Atrial Ablation Versus Continuous Microbubbles Formation and Standard Radiofrequency Ablation Protocols: Comparison of Energy Profiles and Chronic Lesion Characteristics. J Cardiovasc Electrophysiol 2006; 17:72-7. [PMID: 16426405 DOI: 10.1111/j.1540-8167.2005.00300.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiofrequency (RF) energy parameters and chronic lesion characteristics associated with the microbubbles formation have not been yet fully elucidated. OBJECTIVES The objective of this study was to compare the energy profiles and chronic lesion characteristics associated with RF ablation of the pulmonary vein antrum using three different ablation protocols: (1) avoiding microbubbles; (2) continuous microbubble formation; (3) temperature-guided ablation. METHODS A 4-mm tip ablation catheter was used for creating RF ablation lesions in 15 adult mongrel dogs. All ablation lesions were created at the posterior aspect of the PV antrum in each animal. Avoiding microbubbles (group 1, n = 5 dogs, 23 lesions), continuous microbubble formation (group 2, n = 5 dogs, 22 lesions), and temperature-guided (group 3, n = 5 dogs, 19 lesions, target temperature 60 degrees C/power limit 50 W) ablation lesions were analyzed. RESULTS Group 1 showed significantly lower power (19 +/- 8.6 W), lower temperature (50 +/- 4.8 degrees C), higher efficiency-of-heating index (2.9 +/- 0.8 degrees C/W), and lower impedance (109 +/- 24.4 Omega) than groups 2 (38 +/- 8.4 W; 63 +/- 10 degrees C; 1.8 +/- 0.8 degrees C/W; 148 +/- 34.4 Omega) and 3 (44 +/- 12 W; 57 +/- 2.4 degrees C; 1.4 +/- 0.5 degrees C/W; 139 +/- 23.1 Omega) (P < 0.001 vs groups 2 and 3). During ablation, no significant events were detected in group 1, but 11 cases of audible pop, 11 cases of catheter tip charring, and 1 case of fatal myocardial perforation were observed in groups 2 and 3. Transmural lesions were more frequently created in group 1. CONCLUSION RF energy delivery applying "avoiding microbubbles" protocol seems to be associated with higher degree of safety and efficacy when compared to temperature-guided and continuous microbubble-formation ablation protocols.
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Affiliation(s)
- Seil Oh
- Section of Pacing and Electrophysiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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22
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Bruce GK, Bunch TJ, Milton MA, Sarabanda A, Johnson SB, Packer DL. Discrepancies Between Catheter Tip and Tissue Temperature in Cooled-Tip Ablation. Circulation 2005; 112:954-60. [PMID: 16087799 DOI: 10.1161/circulationaha.104.492439] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
It is not known whether catheter tip temperatures with a cooled-tip ablation can be reliably extrapolated to estimate actual tissue temperatures. The relationship between catheter tip temperatures, tissue temperatures, power, and microbubble formation is not known.
Methods and Results—
Nine dogs underwent 111 radiofrequency energy deliveries at the pulmonary vein ostia with a cooled-tip catheter. Catheter tip and tissue temperatures were markedly discrepant. Catheter tip temperature plateaus at 36°C to 39°C with increasing power, whereas tissue temperature increases to a mean of 75±3°C at 45 W (maximum temperature >100°C). Seventy-two energy deliveries were performed, titrating power to microbubble formation guided by intracardiac echocardiography. Type I and II microbubble formation occurred in 45 (63%) and 19 (26%) ablations, respectively. Type I microbubble emergence occurred at lower powers (21±8 versus 26±4 W;
P
=0.05), catheter tip temperatures (38±5°C versus 48±10°C;
P
=0.02), and tissue temperatures (65±19°C versus 81±9°C;
P
<0.001) than type II microbubble formation. Maximum impedance decreases during ablation before microbubble formation were less with type I microbubble (20±9 versus 37±11 Ω;
P
<0.001) compared with type II microbubbles. One quarter of type I microbubbles abruptly transitioned to type II microbubbles with significant changes in power or catheter tip temperature. No microbubbles were seen in 19 ablations (26%) despite powers up to 26±9 W and tissue temperatures up to 81±17°C.
Conclusions—
Catheter tip and tissue temperatures are markedly discrepant during cooled-tip ablation. Type I and II microbubble formation occurs at overlapping power and catheter tip and tissue temperature ranges. Neither the absence of microbubbles nor the presence of type I microbubble formation ensures against excessive tissue heating. The appearance of microbubbles may indicate possible tissue overheating and signal a need to decrease energy.
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Affiliation(s)
- G Keith Bruce
- Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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23
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Rajawat YS, Patel VV, Gerstenfeld EP, Nayak H, Marchlinski FE. Advantages and Pitfalls of Combining Device-Based and Pharmacologic Therapies for the Treatment of Ventricular Arrhythmias:. Observations from a Tertiary Referral Center. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1670-81. [PMID: 15613132 DOI: 10.1111/j.1540-8159.2004.00702.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yadavendra S Rajawat
- Section of Cardiac Electrophysiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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24
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Doi A, Takagi M, Toda I, Teragaki M, Yoshiyama M, Takeuchi K, Yoshikawa J. Real time quantification of low temperature radiofrequency ablation lesion size using phased array intracardiac echocardiography in the canine model: comparison of two dimensional images with pathological lesion characteristics. Heart 2003; 89:923-7. [PMID: 12860873 PMCID: PMC1767768 DOI: 10.1136/heart.89.8.923] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of quantifying low temperature radiofrequency catheter ablation (RFCA) lesions using a phased array intracardiac echocardiography (ICE) catheter--with better tissue penetration and in a deflectable device-in the canine model. INTERVENTION Low temperature radiofrequency (RF) energy (50-60 degrees C at up to 40 W) was delivered to the left ventricle in 11 beagles for 60 seconds, using an 8 French catheter with a deflectable tip and a 4 mm distal electrode. MAIN OUTCOME MEASURES Comparison of the width and depth of RFCA lesions measured by ICE with pathological findings. RESULTS 33 RF energies were delivered in 11 dogs. 31 lesions (94%) were confirmed at necropsy. 27 of 31 ablation lesions (87%) were detected by ICE. The mean (SD) width and depth of the ICE detected lesions were 10.4 (2.6) mm and 5.7 (1.9) mm, respectively. Pathological findings showed that RFCA lesions consisted of inner and outer layers. Macroscopically, the mean (SD) width and depth of the inner layers were 7.6 (2.3) mm and 3.6 (1.2) mm and those for the whole layers were 10.0 (2.8) mm and 5.3 (1.5) mm, respectively. Microscopically, the inner and outer layers corresponded to necrotic and oedematous areas, respectively. The ICE detected lesion size had better correlation with the pathological measurements of the whole layers in width (r = 0.911) and in depth (r = 0.756). CONCLUSION The real time evaluation of RFCA lesion size using the phased array ICE is feasible, even with a low temperature RF application. However, ICE slightly overestimates RFCA lesion size compared with pathological necrotic lesion size.
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Affiliation(s)
- A Doi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
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25
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Marrouche NF, Martin DO, Wazni O, Gillinov AM, Klein A, Bhargava M, Saad E, Bash D, Yamada H, Jaber W, Schweikert R, Tchou P, Abdul-Karim A, Saliba W, Natale A. Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: impact on outcome and complications. Circulation 2003; 107:2710-6. [PMID: 12756153 DOI: 10.1161/01.cir.0000070541.83326.15] [Citation(s) in RCA: 413] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to assess the impact of intracardiac echocardiography (ICE) on the long-term success and complications in patients undergoing pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). METHODS AND RESULTS Three hundred fifteen patients underwent PVI for treatment of AF. Each patient underwent ostial isolation of all PVs using a cooled-tip ablation catheter. PVI was performed using circular mapping (CM) alone (group 1, 56 patients), CM and ICE (group 2, 107 patients), and CM and ICE with titration of radiofrequency energy based on visualization of microbubbles by ICE (group 3, 152 patients). After a mean follow-up time of 417+/-145 days, 19.6% (11 of 56), 16.8% (18 of 107), and 9.8% (15 of 152) of patients in groups 1, 2, and 3 experienced recurrence of AF, respectively. Moreover, whereas no group 3 patient experienced severe (>70%) PV stenosis, severe PV stenosis was documented in 3 (3.5%) of 56 patients in group 1 and in 2 (1.8%) of 107 patients in group 2 (P<0.05). No embolic events were detected in group 3 patients. CONCLUSIONS Intracardiac echocardiography improves the outcome of cooled-tip PVI. Power adjustment guided by direct visualization of microbubble formation reduces the risk of PV stenosis and improves long-term cure.
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Affiliation(s)
- Nassir F Marrouche
- Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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26
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Morton JB, Sanders P, Davidson NC, Sparks PB, Vohra JK, Kalman JM. Phased-array intracardiac echocardiography for defining cavotricuspid isthmus anatomy during radiofrequency ablation of typical atrial flutter. J Cardiovasc Electrophysiol 2003; 14:591-7. [PMID: 12875419 DOI: 10.1046/j.1540-8167.2003.02152.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Cavotricuspid isthmus (CTI) topography includes ridges, pouches, recesses, and trabeculations. These features may limit the success of radiofrequency ablation (RFA) of typical atrial flutter (AFL). The aim of this study was to assess the utility of phased-array intracardiac echocardiography (ICE) for imaging the CTI and monitoring RFA of AFL. METHODS AND RESULTS Fifteen patients (mean age 64 +/- 9 years) underwent ICE assessment (imaging frequency 7.5-10 MHz) before and after RFA of AFL. The ICE catheter was positioned at the inferior vena cava-right atrial junction and the following parameters were measured: (1) CTI length from the tricuspid valve to the eustachian ridge; (2) extent of CTI pouching; and (3) thickness pre/post RFA of the anterior, mid, and posterior CTI. CTI length was 35 +/- 6 mm at end-ventricular systole but shorter (30 +/- 6 mm) and more pouched at end-ventricular diastole (P = 0.02). A pouch or recess was seen in 11 of 15 patients (mean depth 6 +/- 2 mm). The septal CTI was more pouched than the lateral CTI, but the latter had more prominent trabeculations. Trabeculations were seen in 10 of 15 patients, and at these locations the CTI was 4.6 +/- 1 mm thick. Anterior, mid, and posterior CTI thickness pre-RFA was 4.1 +/- 0.8, 3.3 +/- 0.5, and 2.7 +/- 0.9 mm, respectively (P < 0.001 by analysis of variance). ICE guided RFA away from unfavorable CTI features (recesses/thick trabeculations). RFA applications created discrete CTI lesions that coalesced, forming diffuse CTI swelling. Post-RFA thickness was as follows: anterior 4.8 +/- 0.8 mm (P = NS vs pre); mid 3.8 +/- 0.8 mm (P = 0.05 vs pre); and posterior 3.8 +/- 0.8 mm (P = 0.02 vs pre). CONCLUSION Phased-array ICE permits novel real-time CTI imaging with excellent endocardial resolution and may facilitate RFA of AFL.
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Affiliation(s)
- Joseph B Morton
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
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27
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Rajawat YS, Dias D, Gerstenfeld EP, Dixit S, Shah B, Russo AM, Marchlinski FE. Interactions of antiarrhythmic drugs and implantable devices in controlling ventricular tachycardia and fibrillation. Curr Cardiol Rep 2002; 4:434-40. [PMID: 12169241 DOI: 10.1007/s11886-002-0044-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) have proven highly successful in the treatment of life-threatening ventricular arrhythmias. Despite the efficacy of the ICD in terminating ventricular arrhythmias, antiarrhythmic drugs remain an important adjunct to ICD therapy. The use of antiarrhythmic drug therapy in combination with the ICD is synergistic in terms of beneficial effects, but also has the potential for some adverse interactions. Knowledge and recognition of these potential interactions is important for any physician managing patients with an ICD. This review summarizes the benefits and adverse effects of ICD in combination with antiarrhythmic drug therapy, and provides guidelines to ensure safe application of this hybrid therapy.
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Affiliation(s)
- Yadavendra S Rajawat
- University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA
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28
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Bartel T, Müller S, Caspari G, Erbel R. Intracardiac and intraluminal echocardiography: indications and standard approaches. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:997-1003. [PMID: 12217435 DOI: 10.1016/s0301-5629(02)00551-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In particular clinical scenarios, transthoracic and transoesophageal echocardiography (TEE) have limitations. This study sought to test if intracardiac and intraluminal echocardiography (ICLE), including 2-D, M-mode and Doppler analysis with a miniaturised, multiple-frequency transducer-tipped catheter, is suitable for assessing distinct cardiac and vascular disorders. ICLE was employed in 10 animals using 6 standard approaches. In 12 patients undergoing device closure of patent foramina ovalia (PFO) (n = 6) or atrial septal defects (ASD) (n = 3), or aortic stent implantation (n = 3), interventional procedures were guided by ICLE and, for comparison, also by TEE. ICLE provided enhanced diagnostic information on the aorta, cardiac valves, main pulmonary vessels and both atria and, therefore, added to the diagnostic spectrum of TEE. Especially for guiding interventional procedures (e.g., device closure of atrial septal defects and patent foramina ovalia), ICLE was shown to be helpful. Compared with the conventional approach, the technique reduced fluoroscopy time for device closure procedures: 6.5 min vs. 8.9 min, p < 0.0011. With the patient in a supine position, ICLE was better tolerated than TEE. Complications did not occur, either with ICLE or with TEE. In conclusion, ICLE adds to conventional echocardiography and promises to become a clinical alternative for guiding interventional procedures.
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Affiliation(s)
- Thomas Bartel
- Department of Cardiology, Essen University, Essen, Germany.
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29
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Packer DL, Stevens CL, Curley MG, Bruce CJ, Miller FA, Khandheria BK, Oh JK, Sinak LJ, Seward JB. Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization: initial experience with intracardiac phased-array ultrasound. J Am Coll Cardiol 2002; 39:509-16. [PMID: 11823090 DOI: 10.1016/s0735-1097(01)01764-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study was designed to test the feasibility of high-resolution phased-array intracardiac imaging. BACKGROUND Intracardiac echocardiographic imaging of the heart during interventional electrophysiologic (EP) procedures has been limited by inadequate ultrasound penetration and absence of Doppler hemodynamic and flow information produced by rotating mechanical ultrasound elements. METHODS A 10F (3.2 mm) phased-array, variable 5.5 to 10 MHz frequency imaging catheter with a four-way deflectable tip was applied in 24 patients undergoing EP studies. Sixteen prespecified cardiac targets were imaged from a right heart venue. RESULTS Fifteen patients had no underlying organic heart disease; nine had ischemic, cardiomyopathic, valvular or congenital heart disorders. Longitudinal and short-axis imaging readily disclosed each cardiac valve, support structures and chamber, as well as the pericardium, right and left atrial appendages, the junction of the right atrium and superior vena cava, crista terminalis, tricuspid valve isthmus, coronary sinus orifice, membranous fossa ovalis and pulmonary veins. The average target depth was 8.8+/-1.5 cm (range 0.5 to 15 cm), with adequate penetration at a 7.5 MHz imaging frequency. Color flow and Doppler utilities clearly characterized transaortic and pulmonic valve and pulmonary vein blood flow, including during low output states. CONCLUSIONS These first human studies with this technology demonstrate the methods, feasibility and utility of intracardiac phased-array vector and Doppler imaging for long-axis, apex-to-base global cardiac imaging. High resolution of endocardial structures and catheters suggests additional utility for visualizing interventional procedures from the right heart.
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Affiliation(s)
- Douglas L Packer
- Division of Cardiology, Mayo Foundation, Rochester, Minnesota 55905, USA
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30
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Kasai A, Anselme F, Teo WS, Cribier A, Saoudi N. Comparison of effectiveness of an 8-mm versus a 4-mm tip electrode catheter for radiofrequency ablation of typical atrial flutter. Am J Cardiol 2000; 86:1029-32, A10. [PMID: 11053723 DOI: 10.1016/s0002-9149(00)01145-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
An 8-mm catheter does not appear superior to 4-mm tip electrode for atrial flutter ablation. The potential advantage of allowing higher energy delivery on a larger surface is compensated by the lack of consistent contact with the endocardial surface.
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Affiliation(s)
- A Kasai
- Department of Cardiology, Rouen University Hospital, France
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Rodriguez LM, Nabar A, Timmermans C, Wellens HJ. Comparison of results of an 8-mm split-tip versus a 4-mm tip ablation catheter to perform radiofrequency ablation of type I atrial flutter. Am J Cardiol 2000; 85:109-12, A9. [PMID: 11078249 DOI: 10.1016/s0002-9149(99)00618-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thirty consecutive patients with type I atrial flutter were randomized to undergo radiofrequency ablation using an 8-mm split-tip versus a 4-mm tip catheter. Procedural success was high in both groups (100% vs 93%). However, requirement of a fewer number of radiofrequency pulses and fluoroscopy time suggests superiority of the 8-mm split-tip over the 4-mm tip ablation catheter.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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del Rey Sánchez JM, Mercader J, Ripoll E, Álvarez Mogollón T, Correa C, Ortiz Chercoles AI, Moro C, González Rebollo JM, Hernández Madrid A, Socas A, Lobelo R, Peña G. Correlación anatomopatológica y bioquímica de las lesiones producidas por la radiofrecuencia con catéteres estándar e irrigados de 4 mm. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75240-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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