Advanced radiofrequency catheter ablation in canine myocardium

Rosenbaum, R.M.; Greenspon, Arnold J.; Smith, Michael; Walinsky, Paul

doi:10.1016/0002-8703(94)90553-3

Cited by 23 publications

(13 citation statements)

References 14 publications

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“…The present results are in agreement with the findings of earlier published in vivo [12][13][14] and in vitro 15 studies of temperature-and power-controlled radiofrequency ablation in which increased lesion dimensions were found for increasing catheter-tip lengths Յ6 or 8 mm and no further increase was found for longer catheter tips. However, ablation site and convective cooling were not considered in these studies.…”

Section: Tip Lengthsupporting

confidence: 93%

“…In power-controlled ablation, increased tip temperature is associated with larger lesion dimensions, as illustrated by Hindricks et al 29 and Rosenbaum et al 13 This was also illustrated in those of our experiments in which power consumption approached the maximum generator output (pseudo-power-controlled ablation); in this group, reached tip temperature was positively correlated with lesion volume (Figures 2A and 4A). …”

Section: Lesion Volume Related To Average Delivered Power and Averagesupporting

confidence: 85%

“…To improve the success rate in attempts to coagulate the critical parts of the reentrant circuits, 2 approaches can be taken: improving the accuracy of the mapping technique and increasing the size of the lesion created by catheter ablation. Several methods for increasing lesion size have been investigated, ranging from surgery to ablation with direct current, 7,8 laser, 9 microwaves, 10 and alcohol injection 11 to radiofrequency ablation with large-tip [12][13][14][15] or saline-irrigated 16 -19 electrodes. The chosen ablation site may have significant influence on lesion size because of various degrees of cooling of the electrode tip from the intracavitary blood flow, although this has not yet been evaluated systematically.…”

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confidence: 99%

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Lesion Dimensions During Temperature-Controlled Radiofrequency Catheter Ablation of Left Ventricular Porcine Myocardium

et al. 1999

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Background-It is important to increase lesion size to improve the success rate for radiofrequency ablation of ischemic ventricular tachycardia. This study of radiofrequency ablation, with adjustment of power to approach a preset target temperature, ie, temperature-controlled ablation, explores the effect of catheter-tip length, ablation site, and convective cooling on lesion dimensions. Methods and Results-In vitro strips of porcine left ventricular myocardium during different levels of convective cooling and in vivo pig hearts at 2 or 3 left ventricular sites were ablated with 2-to 12-mm-tip catheters. We found increased lesion volume for increased catheter-tip length Յ8 mm in vitro (PϽ0.05) and 6 mm in vivo (PϽ0.0001), but no further increase was found for longer tips. For the 4-to 10-mm catheter tips, we found smaller lesion volume in low-flow areas (apex) than in high-flow areas (free wall and septum) (PϽ0.05). Increasing convective cooling of the catheter tip in vitro increased lesion volume (PϽ0.0005) for the 4-and 8-mm tips but not for the 12-mm tip as the generator reached maximum output. In contrast to power-controlled ablation, we found a negative correlation between tip temperature reached and lesion volume for applications in which maximum generator output was not achieved (PϽ0.0001), whereas delivered power and lesion volume correlated positively (PϽ0.0001). Conclusions-Lesion size differs in different left ventricular target sites, which is probably related to convective cooling, as illustrated in vitro. Longer electrode tips increase lesion size for tip lengths Յ6 to 8 mm. For temperature-controlled ablation, the tip temperature achieved is a poor predictor of lesion size. (Circulation. 1999;99:319-325.)

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Section: Tip Lengthsupporting

confidence: 93%

Section: Lesion Volume Related To Average Delivered Power and Averagesupporting

confidence: 85%

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confidence: 99%

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Lesion Dimensions During Temperature-Controlled Radiofrequency Catheter Ablation of Left Ventricular Porcine Myocardium

et al. 1999

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“…Radio-frequency (RF) trans-catheter ablation is currently the most effective treatment for AF (6) as it can isolate the firing of ectopic foci, typically located around the pulmonary veins (9,10). Unfortunately, RF ablation lesions can vary considerably with catheter contact force, orientation, size and RF energy parameters (6,11,12). Lesion “reconnection” and “recovery” has been a major cause for procedural failure and can necessitate repeat procedures (6,7).…”

Section: Introductionmentioning

confidence: 99%

In vitro photoacoustic visualization of myocardial ablation lesions

et al. 2014

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Background Radiofrequency (RF) ablation to treat atrial arrhythmia is limited by an inability to reliably assess lesion durability and transmurality. Objective Determine feasibility of photoacoustic characterization of myocardial ablation lesions in vitro. In this study, we investigate the feasibility of combined ultrasound (US) and spectroscopic photoacoustic (sPA) imaging to visualize RF ablation lesions in 3-D based on unique differences in the optical absorption spectra between normal and ablated myocardial tissue. Methods Tissue samples were excised from the ventricles of fresh porcine hearts. Lesions were generated using an RF catheter ablation system using 20 - 30 W of power applied for 40 - 60 s. Ablated samples were imaged in the NIR regime (740-780 nm) using a combined PA/US imaging system. Measured PA spectra were correlated to the absorption spectra of deoxy-hemoglobin and ablated tissue to produce a tissue characterization map (TCM) identifying 3-D lesion location and extent. Tissue samples were stained and photographed for gross pathology. TCM and gross pathology images were co-registered to assess TCM accuracy. Results The TCM reliably characterized ablated and non-ablated tissue up to depths of 3 mm. The TCM also assessed lesion position and extent with sub-millimeter accuracy in multiple dimensions. Segmented TCMs achieved greater than 69% agreement with gross pathology. Conclusion These results suggest that sPA imaging has the potential to accurately assess RF ablation lesion size and position with sub-millimeter precision and may be well suited to guide trans-catheter RF atrial ablation in clinical practice.

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“…Extent of myocardial thermal damage depends on electrode diameter, size of the electrode tip, power and duration of RF energy. Heat should be reached up to approximately 50°C to cause the irreversible tissue damage (8,9). Reaching appropriate heat and stable heat level during the procedure is quite important both for the procedure success and decreased complications.…”

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confidence: 99%