Effect of Irrigant Characteristics on Lesion Formation After Radiofrequency Energy Delivery Using Ablation Catheters with Actively Cooled Tips

Nguyen, Duy T.; Olson, Matthew D.; Zheng, Bingbing; Barham, Waseem; Moss, Joshua D.; Sauer, William H.

doi:10.1111/jce.12682

Cited by 95 publications

(90 citation statements)

References 15 publications

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“…As of today, the question of which electrode position provides larger lesions is still controversial. In fact, while some experimental studies reported larger lesions with the electrode in parallel contact [3,[8][9][10], others showed smaller lesion sizes with this position [4,27]. Finally, some studies show that the electrode position did not affect to the lesion size [5] or do not find a consistent pattern [26].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, some studies show that the electrode position did not affect to the lesion size [5] or do not find a consistent pattern [26]. It has been suggested that the larger lesions obtained in perpendicular position could be linked with the fact that this positioning would allow for more external irrigation (namely, the holes providing external irrigation are not occluded, as could occur when the tip is parallel to the tissue) [27]. However, our computational model appears to support the findings in other studies [3,[8][9][10] where larger lesions emerge for the parallel position of the catheter, independently of the irrigation flow rate, the applied power and the contact pressure.…”

Section: Discussionmentioning

confidence: 99%

“…The thermal lesions are determined by their characteristic dimensions (see Fig 1) [3,7,8,22,26]: maximum depth (D), maximum width (MW), depth at the maximum width (DW), and surface width (SW). We assessed the lesion volume (LV) using the formula described in [3,5,27]. …”

Section: Lesion Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

A computational model of open-irrigated electrode for endocardial RF catheter ablation

González-Suárez

Berjano

Guerra

et al. 2015

2015 Computing in Cardiology Conference (CinC)

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Radiofrequency catheter ablation (RFCA) is a routine treatment for cardiac arrhythmias. During RFCA, the electrode-tissue interface temperature should be kept below 80°C to avoid thrombus formation. Open-irrigated electrodes facilitate power delivery while keeping low temperatures around the catheter. No computational model of an open-irrigated electrode in endocardial RFCA accounting for both the saline irrigation flow and the blood motion in the cardiac chamber has been proposed yet. We present the first computational model including both effects at once. The model has been validated against existing experimental results. Computational results showed that the surface lesion width and blood temperature are affected by both the electrode design and the irrigation flow rate. Smaller surface lesion widths and blood temperatures are obtained with higher irrigation flow rate, while the lesion depth is not affected by changing the irrigation flow rate. Larger lesions are obtained with increasing power and the electrode-tissue contact. Also, larger lesions are obtained when electrode is placed horizontally. Overall, the computational findings are in close agreement with previous experimental results providing an excellent tool for future catheter research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A computational model of open-irrigated electrode for endocardial RF catheter ablation

González-Suárez

Berjano

Guerra

et al. 2015

2015 Computing in Cardiology Conference (CinC)

View full text Add to dashboard Cite

show abstract

“…This ex vivo model has been validated and described in further detail elsewhere. 8,9 A 4-mm nonirrigated radiofrequency ablation catheter (Biosense-Webster, Diamond Bar, CA) was positioned with 10 g of force in a perpendicular position using a deflectable sheath (Agilis; St. Jude Medical, St Paul, MN).…”

Section: See Editorial By Hainesmentioning

confidence: 99%

Enhanced Radiofrequency Ablation With Magnetically Directed Metallic Nanoparticles

Nguyen¹,

Tzou²,

Zheng³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Remote heating of metal located near a radiofrequency ablation source has been previously demonstrated.Therefore, ablation of cardiac tissue treated with metallic nanoparticles may improve local radiofrequency heating and lead to larger ablation lesions. We sought to evaluate the effect of magnetic nanoparticles on tissue sensitivity to radiofrequency energy. Methods and Results-Ablation was performed using an ablation catheter positioned with 10 g of force over prepared ex vivo specimens. Tissue temperatures were measured and lesion volumes were acquired. An in vivo porcine thigh model was used to study systemically delivered magnetically guided iron oxide (FeO) nanoparticles during radiofrequency application. Magnetic resonance imaging and histological staining of ablated tissue were subsequently performed as a part of ablation lesion analysis. Ablation of ex vivo myocardial tissue treated with metallic nanoparticles resulted in significantly larger lesions with greater impedance changes and evidence of increased thermal conductivity within the tissue. Magnet-guided localization of FeO nanoparticles within porcine thigh preps was demonstrated by magnetic resonance imaging and iron staining. Irrigated ablation in the regions with greater FeO, after FeO infusion and magnetic guidance, created larger lesions without a greater incidence of steam pops. Conclusions-Metal nanoparticle infiltration resulted in significantly larger ablation lesions with altered electric and thermal conductivity. In vivo magnetic guidance of FeO nanoparticles allowed for facilitated radiofrequency ablation without direct infiltration into the targeted tissue. Further research is needed to assess the clinical applicability of this ablation strategy using metallic nanoparticles for the treatment of cardiac arrhythmias. (Circ Arrhythm Electrophysiol. 2016;9:e003820.

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“…Both microbubbles and microparticles have both been known to increase the risk of MRI-detected SCLs/SCEs. Nguyen et al 107 reported an increased incidence of steam pops with high-power open irrigated catheters using 5% dextrose in water in a perpendicular position compared to other forms of catheter irrigation adding to the data that closed-loop catheters are likely associated with an increased risk of SCLs/SCEs incidence. The use of open irrigated RF catheters also provide a proven advantage of lower complication rates and fewer neurological consequences compared with closed loop design but the operator needs to be wary of the risks of microbubble and microparticle formation with the use of these catheters.…”

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confidence: 99%

Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

Ponamgi¹,

Yasin²,

Padmanabhan³

et al. 2016

JICRM

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ABSTRACT. Despite continued innovations in catheter design and technique, catheter ablation for atrial fibrillation (AF) is still fraught with a few serious complications-most feared of which is stroke. Although a ''classic'' clinically disabling stroke is less common (about 1%) after AF ablation, many recent studies have identified an increased incidence of asymptomatic ischemic cerebral lesions known as ''silent clinical lesions'' (SCLs) associated with the procedure. As once thought, these new SCLs seen on post-ablation magnetic resonance imaging of the brain were not actually clinically ''silent'' and were shown to have significant clinical and neuropsychiatric effects on these patients in the long term. These SCLs are thought to represent the ''embolic fingerprints'' of the ablation procedure, suggesting involvement and the need for innovation as well as improved safety at multiple levels before, during, and after the procedure. This may require a multimodality approach involving several measures such as having better peri-procedural anticoagulation strategies, using real-time monitoring for markers of neurologic injury, giving meticulous attention to sheath management, using novel energy sources that are less thrombogenic, and finally establishing imaging protocols for timely detection of these lesions post ablation. The current literature is reviewed here to explore such opportunities to improve neurological outcomes of catheter ablation for AF.

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Effect of Irrigant Characteristics on Lesion Formation After Radiofrequency Energy Delivery Using Ablation Catheters with Actively Cooled Tips

Cited by 95 publications

References 15 publications

A computational model of open-irrigated electrode for endocardial RF catheter ablation

A computational model of open-irrigated electrode for endocardial RF catheter ablation

Enhanced Radiofrequency Ablation With Magnetically Directed Metallic Nanoparticles

Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

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