Epicardial Ablation With Irrigated Electrodes

Nagashima, Koichi; Watanabe, Ichiro; Okumura, Yasuo; Sonoda, Kazumasa; Kofune, Masayoshi; Matsubara, Hiroaki; Ohkubo, Kimie; Nakai, Toshiko; Kunimoto, Satoshi; Kasamaki, Yuji; Hirayama, Atsushi

doi:10.1253/circj.cj-11-0984

Cited by 22 publications

(11 citation statements)

References 27 publications

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“…In addition, the incidence of steam pops was significantly lower in the BPA setting compared to UPA at the same energy levels [11]. The same group of authors published a related study describing a higher efficacy of bipolar epicardial-to-endocardial ablation in deeper formations and a higher likelihood of transmural lesions compared to standard UPA [22]. Again, the incidence of steam pop was lower when using BPA compared to UPA at the same energy level [22].…”

Section: Preclinical Tissue Model Experience and Animal Bpa Studiesmentioning

confidence: 99%

Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias

Souček

Stárek

2018

CCR

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Section: Preclinical Tissue Model Experience and Animal Bpa Studiesmentioning

confidence: 99%

Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias

Souček

Stárek

2018

CCR

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“…It has been concluded that bipolar ablation of the LV free wall is highly effective at creating an appropriately deep epicardial lesion. Nevertheless, steam pop occurred more often with bipolar ablation [ 23 ]. Bipolar ablation produced also a narrower, deeper lesion than unipolar ablation across the interventricular septum of excised swine hearts [ 24 ].…”

Section: Bipolar Versus Unipolar Ablationmentioning

confidence: 99%

Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

Müssigbrodt

Gutberlet

Dinov

et al. 2015

BioMed Research International

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Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

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“…The steam cavitation effect called a “pop” during ablation is a major complication, sometimes leading to VT and/or cardiac tamponade. There is a substantial discrepancy within the available ex vivo studies regarding steam pop incidence during BPA 10,30 . Importantly, clinical studies have not reported any major complications while ablating in the bipolar mode for miscellaneous arrhythmias 15 .…”

Section: Discussionmentioning

confidence: 99%

Bipolar ablation with contact force‐sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation

Souček

Caluori

Lehar

et al. 2020

Cardiovasc electrophysiol

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Introduction: Despite technical progress, ventricular tachycardia (VT) recurrence after unipolar ablation remains relatively high (12%-47%). Bipolar ablation has been proposed as an appealing solution that may overcome limitations associated with unipolar ablation settings. We designed an animal study to compare bipolar (BPA) vs sequential unipolar ablation (UPA) using contact force-sensing technology on both ablation catheters.Methods: Twenty large white female pigs (6-months-old, 50-60 kg) underwent multiple RF ablations (30 W, 60 seconds, 30 mL/min irrigation) on the ventricular myocardium from the epicardial and endocardial sides. The hearts were fixed and scanned with high-resolution cardiac magnetic resonance imaging. Thermal lesions were located and characterized in volume, depth, width, and transmurality.Results: Lesion volume was calculated as the sum of epicardial or endocardial conjoined/isolated lesions at one location. Linear dimensions (width and depth) were measured twice for each location, on the endocardial and epicardial side. We evaluated 35 lesions across the intraventricular septum (UPA, N = 17 vs BPA, N = 18). No difference in volume, linear dimensions or impedance drop was observed in this area between UPA and BPA. However, BPA required half RF time and showed an increased transmurality trend. We then analyzed 73 lesions from the endocardial side (UPA, N = 35 vs BPA, N = 38) and 50 from the epicardial side (UPA, N = 11 vs BPA N = 39) of the ventricular free walls. Lesion transmurality was markedly improved by BPA (P = .030, odds ratio, 23.73 [4.71,31.96]). Ventricular BPA lesions were significantly deeper on the epicardial side (P < .0001) and endocardial side (P = .015). Conclusion: Bipolar ablation is more likely to create transmural and epicardial lesions in the ventricle wall. Half the time is needed for the creation of comparably deep and large lesions. K E Y W O R D S contact force bipolar ablation, radiofrequency catheter ablation, thermal lesion size, ventricular tachycardia

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Epicardial Ablation With Irrigated Electrodes

Cited by 22 publications

References 27 publications

Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias

Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias

Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

Bipolar ablation with contact force‐sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation

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