P1728Which is a better strategy in pulmonary vein isolation? Contiguous dragging versus point by point catheter ablation utilising tagging technology

Nagahori, Wataru; Kurebayashi, Eigo; Imai, Yuki; Maeno, Tadashi; Oguma, Yasunori; Iwakiri, N.; Nagashima, Michio; Yamashita, Teruo

doi:10.1093/ehjci/eux161.038

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“…With respect to the efficacy of "point by point" and "drag" methods for ablation, the 2017 HRS/EHRA/ECAS/APHRS/ SOLAECE Guidance Documents Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation 79 recognizes that there are "several relevant variables that impact lesion size including catheter stability, contact force, power output, temperature, and duration." At this time, there is no specific guidance suggesting one ablation approach (pointby-point or drag) versus the other: while Yokokawa et al 80 indicated better outcomes for dragging, a larger study was reported by Nagahori et al, 81 which showed the same outcome for both approaches. The long-term goal for this work is to effectively incorporate electrode-contact information into the online ablation lesion modeling and visualization techniques regardless of the ablation approach used.…”

Section: Discussionmentioning

confidence: 99%

Lesion modeling, characterization, and visualization for image-guided cardiac ablation therapy monitoring

et al. 2018

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In spite of significant efforts to improve image-guided ablation therapy, a large number of patients undergoing ablation therapy to treat cardiac arrhythmic conditions require repeat procedures. The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation, in turn leading to the arrhythmia recurrence. Ongoing research efforts aim to better characterize and visualize RF delivery to monitor the induced tissue damage during therapy. Here, we propose a method that entails modeling and visualization of the lesions in real-time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression are quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using bovine tissue samples undergoing clinically relevant ablation protocols. The studies demonstrated less than 5°C difference between the model-predicted and experimentally measured end-ablation temperatures. The model predicted lesion patterns were within 0.5 to 1 mm from the observed lesion patterns, suggesting sufficiently accurate modeling of the ablation lesions. Lastly, our proposed method enables therapy delivery feedback with no significant workflow latency. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.

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Section: Discussionmentioning

confidence: 99%