Randomized Comparison of Multipolar, Duty‐Cycled, Bipolar‐Unipolar Radiofrequency Versus Conventional Catheter Ablation for Treatment of Common Atrial Flutter

Erdoğan, Ali; Guettler, Norbert; Doerr, Oliver; Franzen, W.; Soydan, Nedim; Bilgin, Mehmet; Vogelsang, P.J.; Parahuleva, Mariana; Tillmanns, Harald; Stracke, Siegbert; Guenduez, Dursun; Neuhof, Christiane

doi:10.1111/j.1540-8167.2010.01780.x

Cited by 10 publications

(6 citation statements)

References 14 publications

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“…Another limitation of this study is that catheter systems using conventional RF energy that are available in the United States were compared in this study. It remains to be determined whether novel ablation systems and energy sources will have similar or superior efficacy than 10‐mm tip catheters 21 …”

Section: Discussionmentioning

confidence: 99%

Randomized Comparison of Cavotricuspid Isthmus Ablation for Atrial Flutter Using an Open Irrigation-Tip versus a Large-Tip Radiofrequency Ablation Catheter

Ilg

Kühne

Crawford

et al. 2011

Journal of Cardiovascular Electrophysiology

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Ablation of Typical Atrial Flutte. Background: Large-tip (10 mm) catheters (LTCs) and open-irrigation-tip catheters (OITCs), both capable of creating large lesions, are more effective than conventional catheters for cavotricuspid isthmus (CTI) ablation. However, it is not clear whether complete CTI block can be achieved more efficiently using an LTC or an OITC. The purpose of this study was to compare the efficiency of radiofrequency catheter ablation (RFA) of the CTI using LTC versus OITC to eliminate atrial flutter (AFL).Methods and Results: Sixty consecutive patients (age = 62 ± 10 years) with typical AFL were randomized to undergo RFA of CTI using an LTC (10 mm) or an OITC. If complete CTI block was not achieved by ≤30 minutes of RFA, patients were allowed to cross over to ablation with the other catheter. A 3-dimensional electroanatomical mapping system was used for catheter navigation only with the OITC. The mean duration of RFA to achieve CTI block in 50% of the patients was 6.8 ± 2.2 minutes with an LTC and 11.7 ± 2.7 minutes with an OITC (P = 0.001). After 30 minutes of RFA, CTI block was achieved in 26/30 (87%) and 25/30 patients (83%) using an LTC and an OITC, respectively (P = 1.0). After crossover, CTI block was achieved in 4/5 (80%) and in 4/4 patients (100%) with an LTC and OITC, respectively (P = 1.0). LTC was associated with a lower volume of intravenous fluid administration (388 ± 365 mL versus 865 ± 451 mL, P = 0.0001) and a trend for shorter procedure duration (95± 31 minutes versus 114 ± 50 minutes, P = 0.09) than the OITC. At 6 ± 3 months, 30/30 patients (100%) in the LTC and 27/30 patients (90%) in the OITC groups remained free from AFL, respectively (P = 0.24). Except for one inconsequential steam-pop during RFA with the OITC, there were no complications.Conclusions: Complete CTI block is achieved more rapidly using an LTC than an OITC, and with a similar clinical efficacy

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Section: Discussionmentioning

confidence: 99%

Randomized Comparison of Cavotricuspid Isthmus Ablation for Atrial Flutter Using an Open Irrigation-Tip versus a Large-Tip Radiofrequency Ablation Catheter

Ilg

Kühne

Crawford

et al. 2011

Journal of Cardiovascular Electrophysiology

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“…PDT catheter ablation in the canine CTI model required 8±4 minutes of irradiation time with 16±7 applications in this experiment, whereas the conventional radiofrequency catheter required 14.7±5.2 minutes energy delivery time with 8.9±7.2 applications in human, 23 and 3 to 4.5 minutes of 25 W radiofrequency energy delivery in a canine atrial flutter model with a surgical posterior line in advance. 13 Systemic adverse effects are also potential disadvantages of PDT ablation.…”

Section: Discussionmentioning

confidence: 99%

Nonthermal Cardiac Catheter Ablation Using Photodynamic Therapy

Kimura

Takatsuki

Miyoshi

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Radiofrequency ablation has limitations, largely related to creation of lesions by heating. Here, we report the first nonthermal ablation by applying photodynamic therapy (PDT) to cardiac tissues using a custom-made deflectable laser catheter. The present study investigated the feasibility of PDT for cavotricuspid isthmus ablation in a canine model. Methods and Results-We evaluated the pharmacokinetic profiles of 17 canines after administration of a photosensitizer (talaporfin sodium) by various protocols. We succeeded in maintaining the photosensitizer concentration at a level in excess of the clinically effective dose for humans. Using a 4-polar 7-French deflectable laser catheter, we performed PDT-mediated cavotricuspid isthmus ablation in 8 canines. PDT caused oxidative injury only to the irradiated area and successfully produced a persistent electric conduction block. No acute, gross changes such as edematous degeneration, thrombus formation, steam pops, or traumatic injury were observed after irradiation. Hematoxylin and eosin staining of tissues samples also showed well-preserved endothelial layers. Testing of the blood samples taken before and after the procedure revealed no remarkable changes. Lesion size at 2 weeks after the procedure and the temperature data collected during irradiation were compared between the PDT and irrigated radiofrequency ablation procedures. A ventricular crosssection revealed a solid PDT lesion, which was as deep as a radiofrequency lesion. In addition, endocardial, surficial, and intramural temperature monitoring during the PDT irradiation clearly demonstrated the nonthermal nature of the ablation technique. Conclusions-Nonthermal PDT-mediated catheter ablation is a potentially novel treatment for cardiac arrhythmias.(Circ Arrhythm Electrophysiol. 2013;6:1025-1031.)

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“…SimRFA has been reported in small case series for intramyocardial VA circuits; Yang et al recently reported the largest series to date of six patients undergoing simRFA for intramural septal VT. Both bRFA and simRFA ablation have also been used in multielectrode and circular, multipolar irrigated catheters for ablation of atrial arrhythmias and in pulmonary vein isolation (PVI) in the treatment of atrial fibrillation . In these instances, the distances between the ablation poles are smaller than the distances being targeted for deeper VA circuits.…”

Section: Introductionmentioning

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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Randomized Comparison of Multipolar, Duty‐Cycled, Bipolar‐Unipolar Radiofrequency Versus Conventional Catheter Ablation for Treatment of Common Atrial Flutter

Abstract: The treatment of typical AFL using a hexapolar catheter with a multipolar, duty-cycled, bipolar-unipolar RF generator offers comparable effectiveness relative to conventional RF while providing improved procedural efficiency.

Cited by 10 publications

References 14 publications

Randomized Comparison of Cavotricuspid Isthmus Ablation for Atrial Flutter Using an Open Irrigation-Tip versus a Large-Tip Radiofrequency Ablation Catheter

Randomized Comparison of Cavotricuspid Isthmus Ablation for Atrial Flutter Using an Open Irrigation-Tip versus a Large-Tip Radiofrequency Ablation Catheter

Nonthermal Cardiac Catheter Ablation Using Photodynamic Therapy

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

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