Ablation with an internally irrigated radiofrequency catheter: Learning how to avoid steam pops

Cooper, Joshua M.; Sapp, John L.; Tedrow, Usha B.; Pellegrini, Christine; Robinson, David; Epstein, Laurence M.; Stevenson, William G.

doi:10.1016/j.hrthm.2004.04.019

Cited by 75 publications

(73 citation statements)

References 13 publications

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“…During radiofrequency ablation, irrigated electrodes are prone to deep heating within the tissue, causing steam formation that can explode through the tissue ("steam pops"). 17,20 No cases of tamponade related to radiofrequency ablation occurred in this trial. Perforation seems to be rare during ablation in infarct regions of dense fibrosis.…”

Section: Stevenson Et Al Ventricular Tachycardia Ablation 2779mentioning

confidence: 77%

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

et al. 2008

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Background-Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (PϽ0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study. (Circulation. 2008;118:2773-2782.)

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Section: Stevenson Et Al Ventricular Tachycardia Ablation 2779mentioning

confidence: 77%

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

et al. 2008

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“…15,16 Irrigated and large-tip electrodes are prone to deep heating within the tissue, causing steam formation that can explode through the tissue ("steam pops"). 16,17 Tamponade can occur but is rare during ablation of scar-related left ventricular (LV) tachycardias. The risk is likely greater in the thin-walled right ventricle (RV) and with power Ͼ40 W. External irrigation has been suggested to reduce the risk of thrombus formation, but administration of intravascular saline requires monitoring volume status and often diuresis.…”

Section: Ablation Technologiesmentioning

confidence: 99%

“…The risk is likely greater in the thin-walled right ventricle (RV) and with power Ͼ40 W. External irrigation has been suggested to reduce the risk of thrombus formation, but administration of intravascular saline requires monitoring volume status and often diuresis. 16,17 Experience with catheter cryoablation is limited, but it may pose less risk of injury to adjacent coronary arteries for epicardial ablation than RF ablation. 18,19 …”

Section: Ablation Technologiesmentioning

confidence: 99%

Catheter Ablation for Ventricular Tachycardia

2007

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“…19,20 The greater surface area increases convective cooling in the same level of blood flow. The second, and potentially more effective, approach is fluid irrigation of the electrode either by circulating fluid within the electrode (closed loop system) [21][22][23] or flushing saline through openings in the electrode (open irrigation system). 8,9,14,24 The "active electrode cooling" by irrigation allows sustained RF power, even at sites with low blood flow, to produce deeper lesions.…”

Section: Clinical Perspective P 19mentioning

confidence: 99%

Comparison of Electrode Cooling Between Internal and Open Irrigation in Radiofrequency Ablation Lesion Depth and Incidence of Thrombus and Steam Pop

et al. 2006

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Ablation with an internally irrigated radiofrequency catheter: Learning how to avoid steam pops

Cited by 75 publications

References 13 publications

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

Irrigated Radiofrequency Catheter Ablation Guided by Electroanatomic Mapping for Recurrent Ventricular Tachycardia After Myocardial Infarction

Catheter Ablation for Ventricular Tachycardia

Comparison of Electrode Cooling Between Internal and Open Irrigation in Radiofrequency Ablation Lesion Depth and Incidence of Thrombus and Steam Pop

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