Evaluation of Radiofrequency Ablation Irrigation Type

Tschabrunn, Cory M.; Pothineni, Naga Venkata K.; Sauer, William H.; Doynow, Daniel; Salas, Jonathan; Liao, Ting-Wei Ernie; Arkles, Jeffrey; Hyman, Matthew C.; Frankel, David S.; Supple, Gregory E.; García, Fermin C.; Nazarian, Saman; Dixit, Sanjay; Epstein, Andrew E.; Schaller, Robert D.; Callans, David J.; Marchlinski, Francis E.

doi:10.1016/j.jacep.2020.02.013

Cited by 30 publications

(30 citation statements)

References 9 publications

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“…To our surprise, our study revealed that HNS merely only had a slight advantage over NS in lesion creation, and the results did not achieve statistical significance, in accord with a recently reported study by Tschabrunn et al 15 which described no difference in lesion size between RF ablation with NS versus HNS irrigation in a porcine healthy beating left ventricular model. However, HNS outperformed NS irrigated ablation in lesion width, as depicted in our multivariable linear regression.…”

Section: Discussionsupporting

confidence: 72%

Effects of different ablation settings on lesion dimensions in an ex vivo swine heart model: Baseline impedance, irrigant, and electrode configuration

Jiang

Xiong

et al. 2022

Cardiovasc electrophysiol

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Introduction Intramural or epicardial locations of the arrhythmogenic substrate are regarded as one of the main reasons for radiofrequency (RF) catheter ablation failure. This study aims to conduct a comprehensive analysis of various factors including baseline impedance, irrigant and electrode configuration at similar ablation index (AI) value. Methods In 12 ex vivo swine hearts, RF ablation was performed at a target AI value of 500 and a multistep impedance load (100–180 Ω) in 4 settings: (1) conventional unipolar configuration with an irrigant of normal saline (NS); (2) conventional unipolar configuration with an irrigant of half normal saline (HNS); (3) bipolar configuration with an irrigant of NS; (4) sequential unipolar configuration with an irrigant of NS. The relationships between lesion dimensions and above factors were examined. Results Baseline impedance had a strong negative linear correlation with lesion dimensions at a certain AI. The correlation coefficient between baseline impedance and depth, width, and volume were R = −0.890, R = −0.755 and R = −0.813, respectively (p < .01). There were 10 (total: 10/100, 10%; bipolar: 10/25, 40%) transmural lesions during the whole procedure. Bipolar ablation resulted in significantly deeper lesion than other electrode configurations. Other comparisons in our experiment did not achieve statistical significance. Conclusion There is a strong negative linear correlation between baseline impedance and lesion dimensions at a certain AI value. Baseline impedance has an influence on the overall lesion dimensions among irrigated fluid and ablation configurations. Over a threshold impedance of 150 Ω, the predictive accuracy of AI can be compromised.

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Section: Discussionsupporting

confidence: 72%

Effects of different ablation settings on lesion dimensions in an ex vivo swine heart model: Baseline impedance, irrigant, and electrode configuration

Jiang

Xiong

et al. 2022

Cardiovasc electrophysiol

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“…Recent preclinical work has demonstrated that the utility of low-flow, half-normal saline administered at 40 W for 30 seconds (10 seconds of which involved the ramp-up) and 8 to 14 g of CF led to similar lesions as those attained with normal saline in vivo, albeit the former were slightly deeper (p = 0.07) with an increased incidence of steam pop suggestive of increased tissue heating. 50 This is in keeping with the findings of another recent preclinical study by Leshem et al 51 More adequately powered clinical studies analyzing lesion durability and safety are needed prior to determining the optimal choice of irrigant for RFA.…”

Section: Catheter Optimizationsupporting

confidence: 58%

Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation

Sharif

Heist

2021

J Innov Cardiac Rhythm Manage.

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Radiofrequency ablation (RFA) remains a highly effective therapy in the management of paroxysmal atrial fibrillation (PAF) and is an important therapeutic option in the management of persistent atrial fibrillation (PeAF) when clinically indicated. Lesion size is influenced by many parameters, which include those related to energy application (RFA power, temperature, and time), delivery mechanism (electrode size, orientation, and contact force), and the environment (blood flow and local tissue contact, stability, and local impedance). Successful durable RFA is dependent on achieving lesions that are reliably transmural and contiguous, whilst also avoiding injury to the surrounding structures. This review focuses on the variables that can be adjusted in connection with RFA to achieve long-lasting lesions that enable patients to derive the maximum sustained benefit from pulmonary vein isolation and additional lesion sets if utilized.

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“…A significantly higher incidence of steam pops were noted in the HNS RFA group, with similar lesion depths, widths, and areas between groups. 6 Bennett et al performed a similar analysis utilizing both HNS and D5W irrigant in a beating heart ovine model. Here, ablation was delivered at 30 W, 60-s duration targeting 10-20 g contact force in endocardium and 5-10 g in the epicardium.…”

Section: Discussionmentioning

confidence: 99%

“…Prior ex‐vivo and in vivo animal studies have demonstrated the validity of this technique 5–7 . To date, few analyses have been performed to explore the ex vivo characteristics of HNS irrigated ablation in human hearts.…”

Section: Introductionmentioning

confidence: 99%

Ex‐vivo histopathologic examination of irrigated radiofrequency ablation utilizing half‐normal saline of the human heart

Pillai

Robila

Kasirajan

et al. 2023

Cardiovasc electrophysiol

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Introduction Radiofrequency ablation (RFA) utilizing half‐normal saline (HNS) irrigation is a promising intervention to circumvent commonly encountered limitations during radiofrequency ablation of deep myocardial substrate. Few studies to date have analyzed the morphologic changes in the human myocardium following HNS RFA. Methods and Results Three patients with symptomatic ventricular tachycardia (VT) who underwent RFA with HNS irrigation underwent pathological specimen examination at time of autopsy or following native heart explant at the time of cardiac transplantation. Gross evaluation of the heart was performed fresh and after fixation in 10% formalin. A routine examination was performed with fixation in 10% formalin. Sections of lesioned tissue were paraffin embedded and evaluated using standard hematoxylin and eosin (H&E) staining. Conclusion Irrigated RF ablation with HNS irrigant produces coagulative necrosis as well as several delayed histopathological changes with a deeper field of effective ablation. Transmurality may not be obtained in the ventricular myocardium with endocardial, epicardial, or sequential unipolar HNS ablation.

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Evaluation of Radiofrequency Ablation Irrigation Type

Cited by 30 publications

References 9 publications

Effects of different ablation settings on lesion dimensions in an ex vivo swine heart model: Baseline impedance, irrigant, and electrode configuration

Effects of different ablation settings on lesion dimensions in an ex vivo swine heart model: Baseline impedance, irrigant, and electrode configuration

Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation

Ex‐vivo histopathologic examination of irrigated radiofrequency ablation utilizing half‐normal saline of the human heart

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