Open-irrigated laser catheter ablation: influence of catheter–tissue contact force on lesion formation

Sagerer-Gerhardt, Michaela; Weber, H

doi:10.1007/s10840-015-9977-4

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…The catheter can be brought in intimate contact and stable position upon arrhythmogenic substrates wherever situated in the heart. Taking into consideration this and the above described results of this study, as well as the fact that catheter-tissue contact force is not needed for laser lesion formation [18], it can be assumed that steerable supports may not be needed for successful laser ablation procedures when using the ELMA catheter RytmoLas.…”

Section: Discussionmentioning

confidence: 70%

Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter

Sagerer-Gerhardt

Weber²

2016

Lasers Med Sci

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Lesion sizes and quality are crucial for successful catheter ablation procedures. We sought to test the influence of catheter orientation towards the endocardial surface on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter. Continuous wave 1064-nm laser catheter applications at 15 W (4.5 W/mm²)/30 s, (135 J/mm²), irrigation flow 30 mL/min, were aimed at the left ventricular endocardial surface of bovine myocardium. The catheter was kept in vertical, in slanting (67.5°, 45°, 22.5°), and in flat positions; in flat position, also 60 s of radiation times were applied (n = 10, each). Lesions were evaluated morphometrically. Maximum depth of lesion was achieved with the catheter in a vertical orientation. Catheter inclination of <22.5 showed a highly significant decrease of lesion depth from 5.6 ± 1.1 to 3.7 ± 0.5 mm (p = 0.0001). In a flat catheter position, laser radiation of 30 s achieved the smallest lesions. However, after 60 s of radiation, the flat lesions were similar in depth (p = 087) and were larger in width (p = 0.0004) and in volumes (p = 0.0025) as compared to the lesions achieved with the catheter in vertical position after 30 s of radiation. Steam-pop with intramural cavitation or tissue vaporization with crater formation did not occur. Longer radiation times can achieve larger lesions regardless of catheter orientation. Catheter orientation is not a major determinant for laser ablation lesion size and quality, and a steerable support may not be needed when using the open-irrigated electrode-laser mapping and ablation (ELMA) catheter RytmoLas.

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Section: Discussionmentioning

confidence: 70%

Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter

Sagerer-Gerhardt

Weber²

2016

Lasers Med Sci

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“…Laser lesions can be achieved even without intimate endocardial catheter contact. Catheter contact force and catheter orientation towards the endocardial surface are not major determinants for laser lesion formation [29], [37], [38] . Albeit PVI is still considered the cornerstone for a successful AF ablation we did not target the pulmonary vein specifically, well-directed.…”

Section: Further Considerationsmentioning

confidence: 98%

Laser catheter ablation of long- lasting persistent atrial fibrillation: Longterm results

Weber¹,

Sagerer-Gerhardt²,

Heinze³

2017

Journal of Atrial Fibrillation

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“…Отсутствие эффективных повреждений, в ряде случаев, может быть связано с нестабильностью положения фиброоптического катетера. Однако ранее было установлено, что «сила контакта» не является ключевым для лазерной аблации, в отличие от радиочастотных апппликаций [4]. Тем не менее, мы предполагаем, что роль данного фактора не может быть полностью исключена ввиду отсутствия достаточного контроля электрических сигналов с кончика лазерного катетера, а также ограничений только флюороскопической визуализации для полного контроля позиции катетера.…”

Section: обсуждение полученных результатовunclassified

“…В соответствии с предварительными экспериментальными результатами, лазерная аблация миокарда может иметь преимущества перед рутинно используемой радиочастотной аблацией: большая глубина повреждения, отсутствие необходимости плотного контакта фиброоптического катетера с миокардом при аблации, меньшее повреждение эндокардиальной выстилки по сравнению с радиочастотной аблацией [4]. В то же время, лазерная аблация имеет ряд специфических аспектов, требующих технических решений для достижения требуемого результата аблации, например, исключение наличия слоя крови между фиброоптическим катетером и миокардом.…”

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Acute effects of laser myocardial ablation in <i>ex vivo</i> and <i>in vivo</i>

Leandro

Вахрушев

Korobchenko

et al. 2021

Vestnik aritmologii

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Aim. To study and compare the lesions characteristics of laser energy in heart ex vivo and in experimental large animals.Materials and methods. For the ex vivo experiment a pig heart was obtained from a local slaughterhouse. Laser applications were applied using power 15-30 W in the left and right ventricles 5-50 seconds in duration. Immediately after ablation, examination was performed to determine myocardial damage characteristics at each point. In the experimental study, 7 sheep were included, laser applications were performed under fluoroscopic control in the right atrium with power 10, 15 and 20 W, 10-25 s; in the right ventricle 20, 25 and 30 W for 10-40 s; and in the left ventricle 20, 25 and 30 W for 20-40 s. The animals were euthanized and macroscopic examination of laser lesions was performed.Results. A total of 27 laser applications were performed on the heart ex vivo, all lesions were visualized as white spots on the endocardial surface. The maximum lesion depth was 9 mm achieved when using 20 W /50 s, the maximum lesion diameter was 6 mm, when using 25 W /40 s. The minimum lesion diameter and depth were observed when using 30 W /5 s, 2x1 mm. A total of 48 laser applications were performed in experimental animals, in one experimental animal was observed a transmural lesion in the right atrium when using 15 W /20 s. In 3 out of 7 experimental animals, transmural lesions were observed in the right ventricle when using 20 W /30 s; 20 W /40 s and 30 W /10 s. In the left ventricle, transmural lesions were observed in 2 animals, using 15 W /20 s and 20 W /40 s. In the ex vivo study, there was a strong positive correlation between ablation energy and lesion depth (R=0.91, P<0.05) and lesion volume (R=0.73, P<0.05); while there was no such statistical correlation in vivo.Conclusions. Laser ablation 15-20 W for 15-40 s seems to be optimal for achieving the deepest lesions in the atrium and ventricular myocardium. In our small pilot study with fiberoptic catheter ablation on a beating heart there was no correlation between energy delivered and the depth and volume of necrotic myocardium.

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Open-irrigated laser catheter ablation: influence of catheter–tissue contact force on lesion formation

Cited by 5 publications

References 31 publications

Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter

Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter

Laser catheter ablation of long- lasting persistent atrial fibrillation: Longterm results

Acute effects of laser myocardial ablation in <i>ex vivo</i> and <i>in vivo</i>

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