Catheter Ablation with Radiofrequency Energy: Biophysical Aspects and Clinical Applications

Kalbfleisch, Steven J.; Langberg, Jonathan J.

doi:10.1111/j.1540-8167.1992.tb01106.x

Cited by 30 publications

(7 citation statements)

References 40 publications

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“…Overall, several reasons may explain why insulation material was damaged with RF electrocautery but not with RF ablation. First, RF ablation is distinctly different from the waveform used for RF electrocautery, where high‐voltage, short‐duration pulses with a long duty cycle are designed to promote arcing or coagulum formation . Meanwhile, the RF ablation waveform is a continuous unmodulated sine wave of approximately 550 Hz in a range of 40–60 volts .…”

Section: Discussionmentioning

confidence: 99%

“…13 Meanwhile, the RF ablation waveform is a continuous unmodulated sine wave of approximately 550 Hz in a range of 40-60 volts. 13 Therefore, the temperature achieved by RF catheter ablation is much lower than that achieved by RF electrocautery cut mode. Second, resistive heating may play a role in raising temperature around leads during electrocautery use, since leads are encased in tissue, which limits heat dissipation.…”

Section: Cied Lead Body and Rf Energy Applicationsmentioning

confidence: 99%

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Radiofrequency and Cryo‐Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Darrat

Agarwal

Morales

et al. 2016

Cardiovasc electrophysiol

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Introduction Medical societies and cardiac implantable electronic devices (CIED) manufacturers recommend avoiding close or direct contact between the body of transvenous leads and ablation catheters used to treat cardiac arrhythmias. These recommendations are made despite the lack of clinical studies. However, the target myocardium for successful ablation can be contiguous to CIED leads. Methods and Results We examine in vitro the effects of direct application of radiofrequency (RF) and cryo-ablation energy on the integrity and functionality of CIED leads (excluding the pacing electrodes and defibrillation coils). A saline bath was created to mimic the body milieu. CIED leads, including all commercially available lead insulation materials, were connected to a CIED pulse generator and placed in direct contact with ablation catheter in the tissue bath. RF and cryo-ablation energy were delivered under various conditions, including maximal ablation power, temperature and impedance via the RF generator. CIED lead functionality, reflective of conductor integrity, was evaluated through lead impedance monitoring during ablation. CIED leads were then visually inspected, and examined with optic and electron microscopy as per protocol. A total of 42 leads were studied. All leads showed absence of insulation damage at the site of ablation visually and with microscopy. Lead functionality was also preserved in all leads. Conclusion Catheter ablation in contact with CIED leads using radiofrequency or cryo-ablation in vitro did not affect lead body integrity and function despite aggressive ablation settings. It may be reasonable to perform ablation in contact with the body of CIED leads when clinically necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Cied Lead Body and Rf Energy Applicationsmentioning

confidence: 99%

Radiofrequency and Cryo‐Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Darrat

Agarwal

Morales

et al. 2016

Cardiovasc electrophysiol

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“…The variables determining the extent of damage include, in addition to the size of the catheter tip, the degree of myocardial contact and the power and duration of RF current applied. 34 There are a number of advantages to RF current as compared to direct current shock. First, delivery of RF current is far easier to control.…”

Section: Catheter Ablationmentioning

confidence: 99%

Current Management of the Wolff-Parkinson-White Syndrome

Bartlett

1993

J Cardiac Surgery

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In this review, we discuss the pathophysiology of the Wolff-Parkinson-White (WPW) syndrome and describe medical, surgical, and catheter based principles. WPW syndrome results from the congenital presence of impulse-conducting fascicles, known as accessory pathways (APs) or bypass tracts, which connect atria and ventricles across the annulus fibrosis and are capable of preexciting portions of the ventricular myocardium. Once triggered, atrioventricular reciprocating tachycardias (AVRTs) generally result from depolarization wavefronts moving anterograde through the AV node to the ventricles and returning retrograde to the atria along the AP. Rapid AVRT decreases ventricular filling time and cardiac output, resulting in symptoms. Medications that prolong AP refractory periods (flecainide, propafenone, and amiodarone) prevent rapid AP anterograde conduction (from atria to ventricles) in atrial tachycardias such as atrial fibrillation or flutter. In emergencies, adenosine can be used to terminate the AVRT of WPW syndrome. Otherwise, Class IA or IC antiarrhythmic agents are used to slow AP conduction either with or without AV nodal blocking agents. Open chest surgical ablation of a bypass tract in a symptomatic patient was first reported in 1968. The original endocardial surgical techniques for localizing and dividing APs were refined and an alternative epicardial approach has been developed. Reported mortality rates in experienced hands were 0% to 1.5% in large series for patients without additional cardiac abnormalities. Catheter delivered radiofrequency (RF) energy is now applied intravascularly to ablate APs. Since the first large series of patients undergoing RF ablation was reported in 1989, the procedure had proved safe, cost effective, and well tolerated. RF ablation has become the initial nonpharmacological treatment of choice for WPW syndrome; surgical ablation has become relegated to those cases where symptoms are intolerable and RF ablation is not feasible.

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“…Generally, RF energy used for cardiac ablation is applied as a continuous, unmodulated sine wave at low voltage, whereas that used for electrocautery is high voltage with a long duty cycle that is designed to promote arcing or coagulum formation. 35 Therefore, the temperature achieved by the RF ablation catheter (up to 106.1°C in the study) is much lower than that achieved by the RF electrocautery cut mode, and is much lower than the melting point of polyurethane (185-225°C) or silicone (has no specific melting point). In addition, the cooling effect of circulating blood flow confers a protective mechanism by helping to reduce the temperature when RF ablation energy is applied on or close to transvenous leads.…”

Section: ) Effects Of Ablation Close To or In Direct Contact With A mentioning

confidence: 99%

The Effects of Catheter Ablation on Permanent Pacemakers and Implantable Cardiac Defibrillators

Darrat

Morales

Elayi

2017

JICRM

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Catheter Ablation with Radiofrequency Energy: Biophysical Aspects and Clinical Applications

Cited by 30 publications

References 40 publications

Radiofrequency and Cryo‐Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Radiofrequency and Cryo‐Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Current Management of the Wolff-Parkinson-White Syndrome

The Effects of Catheter Ablation on Permanent Pacemakers and Implantable Cardiac Defibrillators

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