Bipolar Radiofrequency Ablation on Explanted Human Hearts: How to Ensure Transmural Lesions

Khiabani, Ali J.; MacGregor, Robert M.; Manghelli, Joshua L.; Ruaengsri, Chawannuch; Carter, Daniel I.; Melby, Spencer J.; Schuessler, Richard B.; Damiano, Ralph J.

doi:10.1016/j.athoracsur.2020.04.079

Cited by 21 publications

(18 citation statements)

References 17 publications

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“…The ablation device used herein was the bipolar radiofrequency clamps combined with a bipolar radiofrequency pen, given cryothermal energy is not available in China. We performed bipolar radiofrequency clamping in three sets for each lesion line with two applications per set without unclamping, which has been documented to result in 100% atrial lesion transmurality ( 9 ). A complete set of right atrial lines was performed with bipolar radiofrequency ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia

Song

Fan

Zhang

et al. 2021

Front. Cardiovasc. Med.

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The safety and efficacy of the Cox-Maze IV procedure (CMP-IV) for situs inversus dextrocardia patients with atrial fibrillation is yet to be determined. Herein, we present the case of a 39-year-old male patient admitted to our cardiac center following progressive exertional dyspnea. The patient was diagnosed with situs inversus dextrocardia, severe mitral regurgitation, and paroxysmal atrial fibrillation. A three-dimensional (3D) heart model printing device embedded with designated ablation lines was used for pre-operative planning. Mitral valvuloplasty, CMP-IV, and tricuspid annuloplasty were performed. The patient had an uneventful recovery and was in sinus rhythm during a 12-month follow-up period using a 24-h Holter monitoring device. The case herein is one of the first to report on adopting the CMP-IV procedure for situs inversus dextrocardia patients with complex valvuloplasty operation. In addition, the 3D printing technique enabled us to practice the Cox-maze IV procedure, given the patient's unique cardiac anatomy.

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Section: Discussionmentioning

confidence: 99%

Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia

Song

Fan

Zhang

et al. 2021

Front. Cardiovasc. Med.

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“…It is well known that bipolar RF clamps are the most reliable devices for creating transmural lesions 12 . However, our starting idea was strongly supported by the excellent efficacy 5 described using RF clamps either in open procedures with one jaw placed in the endocardium and the outer jaw on the epicardial surface or in an epi‐epicardial closed procedure.…”

Section: Discussionmentioning

confidence: 99%

“…A few years ago, our group pioneered the one‐step hybrid AF ablation technique 2 that has recently been included in the 2020 European Society of Cardiology (ESC) Guidelines for the diagnosis and management of atrial fibrillation 3 . Nonetheless, results show that there is still room for improvement, 4 especially regarding bipolar radiofrequency tools 5 …”

Section: Introductionmentioning

confidence: 99%

In vivo preliminary test of a new biparietal bidirectional bipolar radiofrequency magnetic coupling system

Matteucci

Meir

Maesen

et al. 2021

Pacing Clinical Electrophis

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Background To test in vivo a new design prototype for radio frequency (RF) ablation. Methods A prototype based on a concept of endo‐epicardial biparietal bipolar RF ablation with the atrial tissue interposed and consisting of two specular endocardial‐epicardial catheters was tested in four pigs (80±5 kg). The endocardial catheter was introduced into the left atrium through the left atrial appendage on the beating heart. The epicardial counterpart was placed manually on the atrial epicardial surface. The coupling of the two catheters was achieved using a neodymium magnet around the gold plate electrode, and RF was applied to the interposed tissue. The hearts were excised, and the lesions were examined using morphometric evaluation. Results The RF application resulted in transmural lesions in all of the four animals tested. In these animals the maximum endocardial width (Wendo) was 6.34 ± 0.25, 6.54 ± 0.33, 6.36 ± 0.57, and 6.49 ± 0.96 mm. The pericardial width (Wepi) was similar: 6.37 ± 0.47, 6.58 ± 0.32, 6.35 ± 0.56 and 6.53 ± 0.94 mm. The lesion area was 924.78, 949.25, 944.25, and 926.05 mm2, and the lesion volume was 92.47, 94.92, 94.42, and 92.60 mm3, respectively. Conclusions The idea of an endocardial‐epicardial bidirectional biparietal bipolar radiofrequency tool such that the atrial tissue is fully interposed between the two RF poles might be promising for future clinical applications. Further research is warranted.

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“…In our data analysis, we pooled the data from different hearts, assuming that the random subject factor would not be significant. While this common practice in ablation research [30][31][32] and we balanced the number of nanosecond and millisecond ablations in each heart, a multifactor model to assess the significance of the random subject factor would be the definitive way to justify our assumption. We were not able to perform this multifactor analysis because the metadata associating the fluorescence data with the heart identities were inadvertently deleted in the data analysis process.…”

Section: Limitationsmentioning

confidence: 99%

Electroporation safety factor of 300 nanosecond and 10 millisecond defibrillation in Langendorff-perfused rabbit hearts

2021

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Aims Recently, a new defibrillation modality using nanosecond pulses was shown to be effective at much lower energies than conventional 10 millisecond monophasic shocks in ex vivo experiments. Here we compare the safety factors of 300 nanosecond and 10 millisecond shocks to assess the safety of nanosecond defibrillation. Methods and results The safety factor, i.e. the ratio of median effective doses (ED50) for electroporative damage and defibrillation, was assessed for nanosecond and conventional (millisecond) defibrillation shocks in Langendorff-perfused New Zealand white rabbit hearts. In order to allow for multiple shock applications in a single heart, a pair of needle electrodes was used to apply shocks of varying voltage. Propidium iodide (PI) staining at the surface of the heart showed that nanosecond shocks had a slightly lower safety factor (6.50) than millisecond shocks (8.69), p = 0.02; while PI staining cross-sections in the electrode plane showed no significant difference (5.38 for 300 ns shocks and 6.29 for 10 ms shocks, p = 0.22). Conclusions In Langendorff-perfused rabbit hearts, nanosecond defibrillation has a similar safety factor as millisecond defibrillation, between 5 and 9, suggesting that nanosecond defibrillation can be performed safely.

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Bipolar Radiofrequency Ablation on Explanted Human Hearts: How to Ensure Transmural Lesions

Cited by 21 publications

References 17 publications

Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia

Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia

In vivo preliminary test of a new biparietal bidirectional bipolar radiofrequency magnetic coupling system

Electroporation safety factor of 300 nanosecond and 10 millisecond defibrillation in Langendorff-perfused rabbit hearts

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