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Bahlke F, Wachter A, Erhard N, Englert F, Syväri J, Krafft H, Popa M, Abdiu E, Lennerz C, Telishevska M, Lengauer S, Reents T, Hessling G, Deisenhofer I, Bourier F. Radiofrequency ablation-Real-time visualization of lesions and their correlation with underlying parameters. Pacing Clin Electrophysiol 2024; 47:994-1003. [PMID: 38728067 DOI: 10.1111/pace.14992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/10/2024] [Accepted: 04/09/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Lesion durability and transmurality are crucial for successful radiofrequency (RF) ablation. This study provides a model of real-time RF lesion visualization and insights into the role of underlying parameters, as local impedance (LI). METHODS A force-sensing, LI-sensing catheter was used for lesion creation in an ex vivo model involving cross-sections of porcine cardiac preparations. During 60 s of RF application, one measurement per second was performed regarding lesion size and available ablation parameters. In total, 1847 measurements from n = 36 lesions were performed. Power (20-50 W) and contact force (1-5 g, 10-15 g, 20-25 g) were systematically alternated. RESULTS Lesion formation was most prominent in the first seconds of RF application during which nonlinear lesion growth was observed (max. 1.08 mm/s for lesion depth and 2.71 mm/s for lesion diameter). Power levels determined the extent of lesion formation in the early phase. After 20 s, lesion size growth velocity approaches 0.1 mm/s at all power levels. LI changes were also highest in the first seconds (up to - 12 Ω/s) and decreased to less than - 0.1Ω/s after prolonged application. CONCLUSION Lesion formation in irrigated RF ablation is a nonlinear process. Final lesion size resulting from an RF application is mainly influenced by high rates of lesion growth in the first seconds of ablation. LI seems to be a good surrogate for differentiating changes in lesion formation.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Andreas Wachter
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Edison Abdiu
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
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Narita M, Higuchi S, Kawano D, Sasaki W, Matsumoto K, Tanaka N, Mori H, Tsutsui K, Ikeda Y, Arai T, Nakano S, Kato R, Matsumoto K. Does the same lesion index mean the same efficacy and safety profile: influence of the differential power, time, and contact force on the lesion size and steam pops under the same lesion index. J Interv Card Electrophysiol 2024; 67:147-155. [PMID: 37311981 DOI: 10.1007/s10840-023-01583-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The lesion index (LSI) helps predict the lesion size and is widely used in ablation of various types of arrhythmias. However, the influence of the ablation settings on the lesion formation and incidence of steam pops under the same LSI value remains unclear. METHODS Using a contact force (CF) sensing catheter (TactiCath™) in an ex vivo swine left ventricle model, RF lesions were created with a combination of various power steps (30 W, 40 W, 50 W) and CFs (10 g, 20 g, 30 g, 40 g, 50 g) under the same LSI values (5.2 and 7.0). The correlation between the lesion formation and ablation parameters was evaluated. RESULTS Ninety RF lesions were created under a target LSI value of 5.2, and eighty-four were developed under a target LSI value of 7.0. In the LSI 5.2 group, the resultant lesion size widely varied according to the ablation power, and a multiple regression analysis indicated that the ablation energy delivered was the best predictor of the lesion formation. To create a lesion depth > 4 mm, an ablation energy of 393 J is the best cutoff value, suggesting a possibility that ablation energy may be used as a supplemental marker that better monitors the progress of the lesion formation in an LSI 5.2 ablation. In contrast, such inconsistency was not obvious in the LSI 7.0 group. Compared with 30 W, the 50-W ablation exhibited a higher incidence of steam pops in both the LSI 5.2 and 7.0 groups. CONCLUSIONS The LSI-lesion size relationship was not necessarily consistent, especially for an LSI of 5.2. To avoid any unintentional, weak ablation, the ablation energy may be a useful supportive parameter (393 J as a cutoff value for a 4-mm depth) during ablation with an LSI around 5.2. Thanks to a prolonged ablation time, the LSI-lesion size relationship is consistent for an LSI of 7.0. However, it is accompanied by a high incidence of steam pops. Care should be given to the ablation settings even when the same LSI value is used.
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Affiliation(s)
- Masataka Narita
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Syunta Higuchi
- Department of Medical Engineer, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Wataru Sasaki
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Kazuhisa Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Naomichi Tanaka
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan.
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Takahide Arai
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan
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Matsumoto K, Kawano D, Sasaki W, Tanaka N, Narita M, Mori H, Tsutsui K, Ikeda Y, Arai T, Nakano S, Kato R, Matsumoto K. Detailed investigation of the lesion formation with a novel contact force sensing catheter with a mesh-shaped irrigation tip. J Arrhythm 2023; 39:166-174. [PMID: 37021033 PMCID: PMC10068932 DOI: 10.1002/joa3.12835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Background Recently, a novel contact force (CF) sensing catheter with mesh-shaped irrigation tip (TactiFlex SE, Abbott) was invented and is expected to be useful for safe and effective radiofrequency ablation. However, this catheter's detailed characteristics of the lesion formation are unknown. Methods With an in vitro model, TactiFlex SE and its predecessor, FlexAbility SE, were used. A cross-sectional analysis of 60 s lesions (combination of various energy power settings [30, 40, and 50 W], and CFs [10, 30, and 50 g]) and longitudinal analysis (combination of various powers [40 or 50 W], CFs [10, 30, and 50 g] and ablation times [10, 20, 30, 40, 50, and 60 s]) of both catheters were analyzed and compared. Results One hundred eighty RF lesions were created in protocol 1 and 300 in protocol 2. The lesion formation, impedance changes, and steam pops characteristics were similar between the two catheters. Higher CFs were related to higher incidences of steam pops. A nonlinear, time-dependent increase in the lesion depth and diameter was observed for all power and CF settings, and linear, positive correlations between the RF delivery time and lesion volume were observed for all power settings. Compared with 40 W, a 50 W ablation created greater lesions. Longer durations with higher CF settings had a higher steam pop incidence. Conclusions The lesion formation and incidence of steam pops with TactiFlex SE and FlexAbility SE were similar. A 40 or 50 W ablation with careful CF control not to exceed 30 g in addition to monitoring impedance drops was required to safely create transmural lesions.
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Affiliation(s)
- Kazuhisa Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Daisuke Kawano
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Wataru Sasaki
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Naomichi Tanaka
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Masataka Narita
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Kenta Tsutsui
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Yoshifumi Ikeda
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Takahide Arai
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Kazuo Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
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Sasaki W, Matsumoto K, Higuchi S, Mori H, Fukaya H, Kawano D, Tanaka N, Narita M, Tsutsui K, Ikeda Y, Arai T, Nakano S, Kato R. Detailed analysis of the lesion formation using a diamond tip catheter in an ex vivo experimental model. J Cardiol 2023:S0914-5087(23)00054-0. [PMID: 36935004 DOI: 10.1016/j.jjcc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND A novel Diamond Temp™ (DT; Medtronic, Minneapolis, MN, USA) catheter has enabled performing a surface temperature-controlled ablation. The chemical vapor deposition diamond of the ablation catheter acts as a thermal radiator and is useful for effective cooling of the ablation catheter tip. However, a detailed analysis of the lesion formation with this catheter remains unknown. METHODS DT catheters were used in an excised swine heart experimental model. A cross-sectional analysis of 60-s lesions [a combination of various energy power settings (30, 40, and 50 W), and various contact forces (CF) (10, 30, and 50 g)] and a longitudinal analysis [a combination of various powers (40 W or 50 W), various CFs (10, 30, and 50 g), and various ablation times (5 s, 10 s, 15 s, 20 s, 25 s, 30 s, and 60 s)] of the DT catheter were analyzed. RESULTS The maximum lesion depth, maximum diameter, and lesion volume with a 10 g ablation were significantly lower than those with a 30 g or 50 g ablation. There were no significant differences in the lesion formation between the 30 g ablation and 50 g ablation under each radiofrequency (RF) power setting. The impedance drops with steam pops were significantly greater than those without steam pops (pop (+) vs. pop (-), 26.2 ± 6.6 Ohm vs. 18.4 ± 7.1 Ohm, p = 0.0001). A non-linear, time-dependent increase in the lesion depth and diameter was observed for all power and CF settings. Comparing the lesion depth and diameter between 40 W and 50 W under the same CF setting and same ablation time, most of the settings had no significant difference. CONCLUSION Ablation lesions created with the DT catheter were similar to other catheters. Similar ablation lesions were created with the 40 W or 50 W ablation under the same CF setting and same ablation time. Regardless of the ablation power, monitoring the general impedance during the RF application was indispensable for a safe procedure.
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Affiliation(s)
- Wataru Sasaki
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhisa Matsumoto
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Syunta Higuchi
- Department of Medical Engineer, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan.
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Daisuke Kawano
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Naomichi Tanaka
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Masataka Narita
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Takahide Arai
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
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5
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Fukaya H, Mori H, Oikawa J, Kawano D, Nakamura H, Ishizue N, Kishihara J, Hojo R, Tsutsui K, Ikeda Y, Kato R, Fukamizu S. Optimal local impedance parameters for successful pulmonary vein isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:71-81. [PMID: 36378816 DOI: 10.1111/jce.15748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Local impedance (LI) parameters of IntellaNav STABLEPOINT for successful pulmonary vein isolation (PVI) of atrial fibrillation (AF) remain unclear. The purpose of this study was to seek LI data achieving successful PVI. METHODS Consecutive AF patients who underwent catheter ablation with STABLEPOINT were prospectively enrolled in two centers. PVI was performed under a constant 35-or 40-watt power, 20-s duration, and >5-g contact force. The operators were blinded to the LI data. The characteristics of all ablation points with/without conduction gaps (Unsuccess or Success tags) after the first-attempt PVI were evaluated for the right/left PVs and anterior/posterior wall (RPV/LPV and AW/PW, respectively), and cutoff values of LI data were calculated for successful lesion formation. RESULTS A total of 5257 ablation points in 102 patients (65 [58-72] years old, 65.7% male) were evaluated. The LI drop values were higher in the Success tags than Unsuccess tags on the LPV-AW and RPV-AW/PW (p < .001), except for the LPV-PW (p = .105). The %LI drop values (LI drop/initial LI) were higher for the Success tags in all areas (15.8 [12.2%-19.6%] vs. 11.6 [9.7%-15.6%] in LPV-AW: p < .001, 15.0 [11.5%-19.3%] vs. 11.4 [8.7%-17.3%] in LPV-PW: p = .035, 15.3 [11.5%-19.4%] vs. 9.9 [8.1%-13.7%] in RPV-AW: p < .001, and 13.3 [10.1%-17.4%] vs. 8.1 [6.3%-9.5%] in RPV-PW, p < .001). The LI drop and %LI drop cutoff values were 20.0 ohms and 11.6%, respectively. CONCLUSIONS An insufficient LI drop with STABLEPOINT was associated with a gap formation during PVI, and the best cutoff values for the LI drop and %LI drop were 20.0 ohms and 11.6%, respectively.
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Affiliation(s)
- Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Daisuke Kawano
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Kenta Tsutsui
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshifumi Ikeda
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ritsushi Kato
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
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Tsutsui K, Mori H, Kawano D, Tanaka N, Ikeda Y, Sumitomo N, Iwanaga S, Nakano S, Muramatsu T, Matsumoto K, Kato R. Ablation characteristics and incidence of steam pops with a novel, surface temperature-controlled ablation system in an ex vivo experimental model. Pacing Clin Electrophysiol 2022; 45:1390-1400. [PMID: 36222300 DOI: 10.1111/pace.14597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/23/2022] [Accepted: 09/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND A novel irrigation catheter (QDOT MICRO™) has been introduced, which enables a surface temperature-controlled ablation combined with tip cooling. However, the detailed description of its complex behavior and effect on the incidence of pops and lesion formation remains elusive. This study aimed to systematically investigate the ablation characteristics, feedback behavior, and incidence of steam pops in a simplified ex vivo swine model. METHODS Using swine ventricular tissue perfused with saline at 37°C, we systematically created lesions with 4×3 combinations of the wattage (20, 30, 40, and 50 W) and contact force (CF, 10, 30, and 50 g). Ablation was continued for either 120 s or until a steam pop occurred and repeated 10 times with each setting. The lesion geometry, ablation index, feedback dynamics, and conditions underlying the steam pops were measured and analyzed. RESULTS Steam pops occurred particularly frequently in combinations of a low CF and high power (10 g vs. 30 g+50 g [p < .0001]; 40 W+50 W vs. 20 W+30 W [p < .0001]). Failure to activate a feedback process was associated with a 5.1 times higher incidence of steam pops (21/109 vs.11/11, [95% CI 3.499-7.716], p < .0001). The wattage feedback was particularly evident with a high CF (30 and 50 g) and high initial wattage (40 and 50 W). The average delivered wattage at 27 W predicted the occurrence of steam pops. CONCLUSION The temperature-controlled ablation with the QDOT MICRO™ demonstrated a complex feedback behavior, which contributed to a reduced incidence of steam pops and prolonged lead time to the pops.
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Affiliation(s)
- Kenta Tsutsui
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.,Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Daisuke Kawano
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Naomichi Tanaka
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Shiro Iwanaga
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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Kawano D, Mori H, Tsutsui K, Fukaya H, Tanaka N, Narita M, Sasaki W, Matsumoto K, Ikeda Y, Arai T, Nakano S, Kato R. Time dependency in the radiofrequency lesion formation for a local impedance guided catheter in an ex vivo experimental model. J Arrhythm 2022; 38:1080-1087. [PMID: 36524038 PMCID: PMC9745452 DOI: 10.1002/joa3.12789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 09/10/2024] Open
Abstract
Background The local impedance (LI) is an emerging technology that monitors tissue-catheter coupling during radiofrequency (RF) ablation. The relationships between the LI, RF delivery time, and lesion formation remain unclear. Methods Using an LI-enabled RF catheter in an ex vivo experimental model, RF lesions were created combined with various steps in the power (40 and 50 W), CF (10 g, 30 g, and 50 g), and time (10s, 20s, 30s, 40s, 50s, and 60s at 40 W and 5 s, 10s, 20s, 30s, 40s, 50s, and 60s at 50 W). The correlations between the LI drop, lesion size, and RF delivery time were evaluated. The rate of change in the time-dependent gain in the LI, depth, and diameter and the time to reach 90% decay of the peak dY/dT (time to 90% decay) were assessed. Results The correlation between the LI drop and ablation time revealed non-linear changes. The time to a 90% decay in the LI drop differed depending on the RF ablation setting and was always shorter with the 50 W setting than 40 W setting. The LI drop always correlated with the lesion formation under all ablation power settings. Deeper or wider lesions were predominantly created within the time to 90% decay of the LI drop. Conclusion The LI drop was useful for predicting lesion sizes. Deeper or wider lesions cannot be obtained with a longer ablation than the 90% decay time of the LI drop. A shorter ablation than the 90% decay time of the LI drop would be preferable for an effective ablation.
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Affiliation(s)
- Daisuke Kawano
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Kenta Tsutsui
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Hidehira Fukaya
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Naomichi Tanaka
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Masataka Narita
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Wataru Sasaki
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Kazuhisa Matsumoto
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Yoshifumi Ikeda
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Takahide Arai
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University, International Medical CenterHidakaJapan
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Matsuura G, Fukaya H, Ogawa E, Kawakami S, Mori H, Saito D, Sato T, Nakamura H, Ishizue N, Oikawa J, Kishihara J, Niwano S, Ako J. Catheter contact angle influences local impedance drop during radiofrequency catheter ablation: Insight from a porcine experimental study with 2 different LI-sensing catheters. J Cardiovasc Electrophysiol 2022; 33:380-388. [PMID: 35018687 DOI: 10.1111/jce.15356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Local impedance (LI) can indirectly measure catheter contact and tissue temperature during radiofrequency catheter ablation (RFCA). However, data on the effects of catheter contact angle on LI parameters are scarce. This study aimed to evaluate the influence of catheter contact angle on LI changes and lesion size with 2 different LI-sensing catheters in a porcine experimental study. METHODS Lesions were created by the INTELLANAV MiFi™ OI (MiFi) and the INTELLANAV STABLEPOINT™ (STABLEPOINT). RFCA was performed with 30 watts and a duration of 30 seconds. The CF (0, 5, 10, 20, and 30 g) and catheter contact angle (30°, 45°, and 90°) were changed in each set (n=8 each). The LI rise, LI drop, and lesion size were evaluated. RESULTS The LI rise increased as CF increased. There was no angular dependence with the LI rise under all CFs in the MiFi. On the other hand, the LI rise at 90° was lower than at 30° under 5 and 10 g of CF in STABLEPOINT. The LI drop increased as CF increased. Regarding the difference in catheter contact angles, the LI drop at 90° was lower than that at 30° for both catheters. The maximum lesion widths and surface widths were smaller at 90° than at 30°, whereas there were no differences in lesion depths. CONCLUSION The LI drop and lesion widths at 90° were significantly smaller than those at 30°, although the lesion depths were not different among the 3 angles for the MiFi and STABLEPOINT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Emiyu Ogawa
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Sota Kawakami
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Tsutsui K, Kawano D, Mori H, Kato R, Ikeda Y, Sumitomo N, Fukaya H, Iwanaga S, Nakano S, Muramatsu T, Matsumoto K. Characteristics and optimal ablation settings of a novel, contact-force sensing and local impedance-enabled catheter in an ex vivo perfused swine ventricle model. J Cardiovasc Electrophysiol 2021; 32:3187-3194. [PMID: 34559441 DOI: 10.1111/jce.15253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/25/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local impedance (LI) has emerged as a new technology that informs on electrical catheter-tissue coupling during radiofrequency (RF) ablation. Recently, IntellaNav StablePoint, a novel LI-enabled catheter that equips contact force (CF) sensing, has been introduced. Although StablePoint and its predecessor IntellaNav MiFi OI share the common technology that reports LI, distinct mechanics for LI sensing between the two products raise a concern that the LI-RF lesion formation relationship may differ. METHODS In an ex vivo swine cardiac tissue model, we investigated the initial level and range of a reduction in LI during a 60-s RF ablation and the resultant lesion characteristics at nine combinations of three energy power (30, 40, and 50 W) and CF (10, 30, and 50 g) steps. Correlations and interactions between CF, LI, wattage, and formed lesions were analyzed. Incidence of achieving LI drop plateau and that of a steam pop were also determined. RESULTS Positive correlations existed between CF and initial LI, CF and absolute/relative LI drop, CF and lesion volume, and LI drop and lesion volume. At the same LI drop, wattage-dependent gain in lesion volume was observed. Steam pops occurred in all CF steps and the prevalence was highest at 50 W. LI drop predicted a steam pop with a cutoff value at 89Ω. CONCLUSION In StablePoint, wattage crucially affects LI drop and lesion volume. Because 30 W ablation may by underpowered for intramural lesion formation and 50 W often resulted in a steam pop, 40 W appears to achieve the balance between the safety and efficacy.
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Affiliation(s)
- Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
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