Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter

Nazer, Babak; Walters, Tomos E.; Duggirala, Srikant; Gerstenfeld, Edward P.

doi:10.1161/circep.116.004760

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…In comparison to previous epicardial RF ablation studies ( 11 , 12 ), the laser ablation resulted in deeper and more homogeneous lesions. Ex vivo studies already showed that increasing the power above 30 W did not create deeper lesions.…”

Section: Discussioncontrasting

confidence: 61%

“…Overall, the deflectable 20-mm linear laser catheter showed good performance regarding lesion depth and procedural safety in endo- and epicardial ablations. The achieved maximum ventricular lesion depths are slightly deeper than the conventional RF- and cryo devices ( 11 , 12 ), but also compared to upcoming technologies like pulsed-field ablation ( 18 ). As for all thermal ablation devices, achieving tissue contact is critical for lesion formation when delivering energy.…”

Section: Discussionmentioning

confidence: 90%

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A Novel Laser Energy Ablation Catheter for Endocardial Cavo-Tricuspid Isthmus Ablation and Epicardial Ventricular Lesion Formation: An in vivo Proof-of-Concept Study

Krist¹,

Linz²,

Schotten³

et al. 2022

Front. Med. Technol.

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AimThis proof-of-concept study aimed to investigate atrial and ventricular lesion formation by a 20-mm linear laser ablation catheter, regarding lesion depth and tissue damage.MethodsIn total, 6 female swines underwent standard femoral vein access to introduce a novel 20-mm linear laser ablation catheter in the right atrium to perform endocardial cavotricuspid isthmus (CTI) ablations. The navigation took place under fluoroscopy with additional visualization by intracardiac echocardiograph. Via a sternotomy, epicardial ablations were performed on the surface of the left ventricle (LV), right ventricle (RV), and right atrial appendage (RAA). Procedural safety was assessed by registration of intraprocedural adverse events and by macroscopic examination of the excised hearts for the presence of charring or tissue disruption at the lesion site.ResultsAltogether 39 lesions were created, including 8 endocardial CTI (mean lesion length 20.6 ± 1.65 mm), 26 epicardial ventricle (mean lesion length LV: 25.3 ± 1.35 mm, RV: 24.9 ± 2.40 mm), and 5 epicardial appendage ablations (mean lesion length RAA: 26.0 ± 3.16 mm). Transmurality was achieved in all CTI and atrial appendage ablations, in 62% of the RV ablations and in none of the LV ablations. No perforation or steam pop occurred, and no animal died during the procedure.ConclusionIn this porcine study, the 20-mm linear laser ablation catheter has shown excellent results for endocardial cavotricuspid isthmus ablation, and it resulted in acceptable lesion depth during atrial and ventricular epicardial ablation. The absence of tissue charring, steam pops, or microbubbles under the experimental conditions suggests a high degree of procedural safety.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 90%

A Novel Laser Energy Ablation Catheter for Endocardial Cavo-Tricuspid Isthmus Ablation and Epicardial Ventricular Lesion Formation: An in vivo Proof-of-Concept Study

Krist¹,

Linz²,

Schotten³

et al. 2022

Front. Med. Technol.

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“…In a recent study, we have described optimal settings for ablation in the bipolar configuration, as well as reported on our experience with bRFA using two irrigated catheters for patients with midmyocardial VA circuits . Simultaneous ablation from a multipolar catheter has also been studied in ex vivo and in vivo models and shown to be more effective than focal sequential ablation …”

Section: Introductionmentioning

confidence: 99%

“…4 Simultaneous ablation from a multipolar catheter has also been studied in ex vivo and in vivo models and shown to be more effective than focal sequential ablation. 7 Although the effectiveness of bipolar ablation has been compared to sequential unipolar ablation, there is limited data on simultaneous unipolar ablation (simRFA). SimRFA has been reported in small case series for intramyocardial VA circuits 8,9 ; Yang et al 10 recently reported the largest series to date of six patients undergoing simRFA for intramural septal VT.…”

mentioning

confidence: 99%

Bipolar radiofrequency ablation creates different lesion characteristics compared to simultaneous unipolar ablation

Nguyen

Zheng²,

Zipse³

et al. 2019

Cardiovasc electrophysiol

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Introduction Both bipolar and simultaneous radiofrequency ablation (bRFA, simRFA) have been used to treat thick midmyocardial substrate as well as during circular, multipolar ablation between shorter distances. Objectives We sought to evaluate the biophysical parameters of simRFA, sequential unipolar RFA (seqRFA), and bRFA. Methods Bovine myocardium was placed in a circulating saline bath. To simulate thick substrate conditions, two open irrigated ablation catheters were oriented across from each other, with myocardium in between. Thermocouples were placed in the center, ±2 mm, of the myocardium. Unipolar ablations were performed sequentially or simultaneously at 50 W for 60 seconds and compared to bRFA using the same settings. In addition, to simulate multipolar ablation, two open irrigated ablation catheters were oriented on the same side and perpendicular to myocardium at 1, 2, and 4 mm spacing. SimRFA were performed at 15 and 25 W for 60 seconds and compared to bRFA. Results For thicker tissue, simRFA produced similar lesion volume and depth compared to bRFA but with a lesion geometry similar to seqRFA. Unlike seqRFA and simRFA, bRFA had a necrotic core spanning the myocardium. Core depths, volumes, and temperatures were significantly greater for bRFA lesions compared to simRFA or seqRFA (Figure, P < .001). Similar results were consistent for bRFA and simRFA at shorter spacings. Conclusions BRFA has greater core lesion temperatures, corresponding to a denser and larger necrotic core, than either simRFA or seqRFA. This may have implications for considering the optimal strategy for deep midmyocardial substrates or during multipolar ablation.

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“…It could reduce or eliminate the need for epicardial ablation and even more importantly allow for the ablation of the epicardial substrate underneath coronary arteries, a currently significant limitation. The use of a multipolar irrigated RF catheter to ablate VT substrate has also been reported and could be considered as an alternative to current catheters. However, these catheters are having similar RF delivery characteristics, only multiplied by the number of ablation electrodes.…”

Section: Discussionmentioning

confidence: 99%

Larger and deeper ventricular lesions using a novel expandable spherical monopolar irrigated radiofrequency ablation catheter

Kitamura

Hocini

Bourier

et al. 2019

Cardiovasc electrophysiol

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Background Radiofrequency (RF) ablation is an established treatment for ventricular tachycardia (VT). However, the inability of current RF catheters to address deep or large substrate may explain most of the clinical failures. Objectives The aim of this study is to assess the efficacy and safety of ablation in the left ventricle (LV) in sheep using a novel 8‐Fr deflectable ablation catheter (Sphere‐9; Affera, Inc) with a 9‐mm expandable spherical monopolar irrigated RF tip vs a standard RF irrigated catheter (Biosense Webster, Diamond Bar, CA). The impact on tissue was assessed on local bipolar electrograms (from nine uniformly distributed mini surface electrodes and an internal central reference electrode), as well as on direct lesion measurement post mortem. Methods and Results Eleven sheep underwent LV endocardial ablation in healthy tissue using the Sphere‐9 catheter (n = 6), or a conventional irrigated RF catheter (n = 5). Twenty lesions were created with the Sphere‐9 (current limit: 2.7 A; temp. limit: 60°C; irrigation: 30 mL/min; and duration: 60‐120 seconds). Local bipolar electrograms at the surface of the catheter disappeared during RF delivery in 17 of 20 (85%) lesions. The mean lesion volume was 1707 ± 771 mm 3 (length: 15.8 ± 3.3 mm; width: 11.6 ± 4.2 mm; and depth: 10.3 ± 2.9 mm). Twenty‐five lesions were created with a standard RF irrigated catheter (power control 35 W; irrigation: 30 mL/min; duration: 60 seconds; volume 537 ± 398 mm 3; length: 8.2 ± 2.3 mm; width: 5.2 ± 1.8 mm; and depth: 5.5 ± 2.4 mm). The novel spherical RF catheter created significantly larger lesions ( P < .001 for measurements in all dimensions). There were no steam pops with the novel ablation catheter vs one with the conventional catheter. Conclusions This novel spherical monopolar irrigated RF catheter creates lesions that are twice as large and deep as a standard irrigated RF catheter.

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Feasibility of Rapid Linear-Endocardial and Epicardial Ventricular Ablation Using an Irrigated Multipolar Radiofrequency Ablation Catheter

Cited by 9 publications

References 25 publications

A Novel Laser Energy Ablation Catheter for Endocardial Cavo-Tricuspid Isthmus Ablation and Epicardial Ventricular Lesion Formation: An in vivo Proof-of-Concept Study

A Novel Laser Energy Ablation Catheter for Endocardial Cavo-Tricuspid Isthmus Ablation and Epicardial Ventricular Lesion Formation: An in vivo Proof-of-Concept Study

Bipolar radiofrequency ablation creates different lesion characteristics compared to simultaneous unipolar ablation

Larger and deeper ventricular lesions using a novel expandable spherical monopolar irrigated radiofrequency ablation catheter

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