Characteristics of Radiofrequency Catheter Ablation Lesion Formation in Real Time In Vivo Using Near Field Ultrasound Imaging

Wright, Matthew; Harks, Erik; Deladi, S.; Fokkenrood, Steven; Brink, Rob C.; Belt, H.J.W.; Kolen, Alexander F.; Rankin, Darrell; Stoffregen, William C.; Cockayne, Debra A.; Cefalu, Joseph; Haines, David E.

doi:10.1016/j.jacep.2018.04.002

Cited by 29 publications

(24 citation statements)

References 20 publications

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“…Our case corroborates the theory of the creation of an inside-out lesion, meaning that burns initially develop in the esophageal mucosa and progress toward the LA facilitating fistula. The geometry of lesions formed by irrigated catheter is teardrop-shaped with the largest lesion projected deeper into tissue leading to esophageal injury first [3]. This was recently demonstrated in vivo in animal models [3] and was also observed in a single case report, where a patient refused surgery and serial CT images documented the progression of an esophageal ulcer to complete fistulization to the LA [4].…”

Section: Case Presentationmentioning

confidence: 86%

“…The geometry of lesions formed by irrigated catheter is teardrop-shaped with the largest lesion projected deeper into tissue leading to esophageal injury first [3]. This was recently demonstrated in vivo in animal models [3] and was also observed in a single case report, where a patient refused surgery and serial CT images documented the progression of an esophageal ulcer to complete fistulization to the LA [4]. The limited effectiveness of preventive measures, makes a high index of suspicion and early recognition and treatment of paramount importance.…”

Section: Case Presentationmentioning

confidence: 99%

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Surgical repair of an esophageal perforation after radiofrequency catheter ablation for atrial fibrillation

Badertscher

Delko

Oertli

et al. 2019

Indian Pacing and Electrophysiology Journal

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Recent reports have described the incidence of atrioesophageal fistulas (AEF), often resulting in death, from radiofrequency (RF) catheter ablation of atrial fibrillation (AF). 1 Cases of esophageal perforation without concomitant AEF have not been described as extensively. 1 The precise mechanisms leading to esophageal injury after catheter ablation without involvement of the left atrium are not fully understood. The surgical approach to treat esophageal perforation is strongly recommended. 2 However, a unified surgical treatment approach has not yet been established. We describe a case of successful surgical repair of an esophageal perforation after ablation using surgical repair in combination with an omental wrap.

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Section: Case Presentationmentioning

confidence: 86%

Section: Case Presentationmentioning

confidence: 99%

Surgical repair of an esophageal perforation after radiofrequency catheter ablation for atrial fibrillation

Badertscher

Delko

Oertli

et al. 2019

Indian Pacing and Electrophysiology Journal

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“…Moreover, patients with implantable devices, such as pacemakers or implantable cardioverter defibrillators, may not be able to undergo MRI‐based evaluation. Intracardiac echocardiography was regarded as an alternative approach . However, the relatively low resolution (100‐150 μm) limits its image quality …”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation lesion assessment using optical coherence tomography – a proof‐of‐concept study

Liang

Taeschler

Goepfert

et al. 2019

Cardiovasc electrophysiol

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Background: Radiofrequency catheter ablation (RFA) is an effective treatment for atrial fibrillation. However, ablation lesions are usually only assessed functionally. The immediate effect of RFA on the tissue is not directly visualized. Optical coherence tomography (OCT)is an imaging technique that uses light to capture high-resolution images with histology-like quality. Therefore, it might be used for high-precision imaging of ablation lesions.Methods and results: Radiofrequency ablation lesions (n = 25) were produced on the freshly excised left and right ventricular porcine endocardium. A Thermocool ST SF NAV ablation catheter (Biosense Webster Inc) and an EP-Shuttle ablation generator (Stockert GmbH) were used to produce ablation lesions with powers from 10 to 40 W (energies ranging from 100 Ws to 900 Ws). After ablation, the tissue was imaged with a swept source OCT system (at a wavelength of 1300 nm). Subsequently, the ablation lesions underwent the histological analysis. The ablation lesions could be visualized by OCT in all 17 samples with ablation powers ≥20 W, meanwhile, no lesion could be observed in the other eight samples with lower power (10 W). Lesion depths and lesion radiuses, as assessed by OCT, correlated well with those observed on the subsequent histological analysis (Spearman's r = 0.94, P < 0.001 and r = 0.84, P < 0.001). In addition, successful three-dimensional reconstructions of ablation lesions were performed.Conclusion: OCT can provide a visual high-resolution assessment of ablation lesions. K E Y W O R D S ablation lesion, atrial fibrillation (AF), imaging, optical coherence tomography (OCT), radiofrequency 1 | INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with significant morbidity and devastating outcomes, such as ischemic strokes. The main mechanism initiating AF is the electrical activity from the triggers located mostly in the pulmonary veins (PVs). 1 PV isolation by radiofrequency ablation (RFA) is an effective treatment for symptomatic patients with AF. 2 Successful PV isolation by radiofrequency catheter intervention requires transmural and closely adjacent lesions around the PV ostia in the left atria. Recurrence of AF after ablation is related to insufficient continuity of the ablation lesion line and ablation lesion depth. 3 On the contrary, excessive energy applied to the thin atrial wall may cause serious complications during and after RFA. These include J Cardiovasc Electrophysiol. 2019;30:934-940. wileyonlinelibrary.com/journal/jce PTAH staining analysis. We also acknowledge the China Scholarship Council for financial support to Mr. D. Liang and the Swiss Heart Rhythm Foundation for financial support to Dr. A. Haeberlin. ORCID Deming Liang

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“…In the context of lesion physiology, an acute A-EGM-biV reduction immediately after ablation in central zone close to ablation core corresponds most likely to direct thermal injury. However, since immediate oedema formation during RF delivery was observed in the real-time ultrasound study (27), its participation in early attenuation of A-EGM cannot be ruled out. Interestingly, the voltage reduction after ablation has asymmetrical distribution with larger voltage reduction in segments adjacent to PV ostia.…”

Section: Discussionmentioning

confidence: 99%

Early and Delayed Alteration of Atrial Electrograms Around Single Radiofrequency Ablation Lesion

Havránek

Alfredova

Fingrová

et al. 2019

Front. Cardiovasc. Med.

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Purpose: The acute effect of radiofrequency (RF) ablation includes local necrosis and oedema. We investigated the spatiotemporal change of atrial electrograms in the area surrounding the site of single standardized pulse of RF energy.Methods: The study enrolled 12 patients (45–67 years, 10 males) with paroxysmal atrial fibrillation (AF) undergoing ablation procedure with irrigated-tip ablation catheter and 3D navigation. The high-density mapping/remapping (129 ± 63 points) within the circular area with radius of ~10 mm, centered at the pre-specified posterior left pulmonary vein antrum ablation site was performed at baseline, immediately after single RF energy delivery (25 W, 30 s, 20 ml/min) and after 30 min waiting period. Bipolar voltages of atrial electrograms (A-EGM-biV) were averaged within the central and 12 adjacent left atrium segments and their relative change was studied.Results: After the ablation, overall A-EGM-biV within the mapping zone (3.51 ± 1.89 mV at baseline) reduced to 2.83 ± 1.77 mV (immediately) and to 2.68 ± 1.58 mV (after 30 min waiting period). In per-segment pair-wise comparison, we observed highly significant change in A-EGM-biV that extended up to the distance of 8.8 mm from the lesion core. The maximum early A-EGM-biV attenuation by 39–49% (P < 0.001) was registered in segments adjacent to pulmonary vein ostia. The subsequent (delayed) A-EGM-biV reduction by 17–24% (P < 0.05) was observed in opposite direction from the lesion center.Conclusions: Significant alteration of atrial electrograms was detectable rather distant from the central lesion. Spatiotemporal development of ablation lesion was eccentric/asymmetric. While acute A-EGM-biV reduction can be attributed predominantly to direct thermal injury, delayed effects are probably due to oedema progression.

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Characteristics of Radiofrequency Catheter Ablation Lesion Formation in Real Time In Vivo Using Near Field Ultrasound Imaging

Abstract: NFUS was effective in imaging RF catheter ablation lesion formation in real time. It was useful in assessing the dynamics of lesion growth and could visualize impending steam pops. It may be a useful technology to improve both safety and efficacy of RF catheter ablation.

Cited by 29 publications

References 20 publications

Surgical repair of an esophageal perforation after radiofrequency catheter ablation for atrial fibrillation

Surgical repair of an esophageal perforation after radiofrequency catheter ablation for atrial fibrillation

Radiofrequency ablation lesion assessment using optical coherence tomography – a proof‐of‐concept study

Early and Delayed Alteration of Atrial Electrograms Around Single Radiofrequency Ablation Lesion

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