Relationship Between Catheter Forces, Lesion Characteristics, “Popping,” and Char Formation: Experience with Robotic Navigation System

Biase, Luigi Di; Natale, Andrea; Barrett, Conor D.; Tan, Carmela D.; Elayi, Claude S.; Ching, Chi Keong; Wang, Paul; Al‐Ahmad, Amin; Arruda, Mauricio; Burkhardt, J. David; Wisnoskey, Brian J.; Chowdhury, P.; Marco, R N Shari De; Armaganijan, Luciana; Litwak, Kenneth N.; Schweikert, Robert A.; Cummings, Jennifer E.

doi:10.1111/j.1540-8167.2008.01355.x

Cited by 147 publications

(103 citation statements)

References 22 publications

(20 reference statements)

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“…636,665,666,667 No effective lesion is formed without adequate CF, and excessive CF is associated with excessive deep tissue heating and an increased risk of deep steam pop (and perforation) and injury outside the heart, such as esophageal, pulmonary, and PN injury.…”

Section: Section 6: Technology and Toolsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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1,468

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Section: Section 6: Technology and Toolsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

Self Cite

1,769

1,468

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“…In contrast, excessively high CFs have been shown in animal models to be associated with steam pop and crater formation, and consciously avoiding such high forces with CF visualisation may reduce complication rates. 32 Impedance values during mapping and impedance drop that occurs at the start of RF application was also shown to correlate with CF, which has since been confirmed in a recent publication by Reichlin et al 33 Secondly, comparison of CF guided with non-CF guided LA mapping and PVI ablation was performed, and the impact of CF on AF recurrence was analysed. A total of 70 patients underwent PVI, in which operators were blinded to CF data in 35 patients, and CF was displayed in the other 35.…”

Section: The Impact Of Contact Forcementioning

confidence: 96%

ThermoCool® SmartTouch® Catheter – The Evidence So Far for Contact Force Technology and the Role of VisiTag™ Module

Lin¹,

Ouyang²,

Kück

et al. 2014

Arrhythm Electrophysiol Rev

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Catheter ablation has become an important modality in the treatment of most cardiac arrhythmias. In recent years there has been significant development of new ablation energies and technologies in an attempt to improve clinical outcomes and decrease disease burden. Ablation failure is often associated with inadequate lesion formation, and catheter-to-myocardial contact force (CF) and catheter stability are two of the parameters required to produce effective lesions during radiofrequency energy application. Recently, CF sensing catheters and tagging modules have been developed to give operators realtime data on catheter force and stability. This review describes the novel ThermoCool® SmartTouch® Catheter (Biosense Webster Inc., CA, US) and VisiTag Module (Biosense Webster Inc., CA, US) software, and discusses the results of several studies on CF and catheter stability during mapping and ablation of the left atrium and ventricle from our electrophysiology laboratory. We assess the short- and longer-term outcomes during mapping and ablation with and without CF data, as well as the use of the VisiTag Module™ software, which allows the evaluation of multiple parameters of lesion formation, then integrates and displays this as automatic tags in a relatively objective way.

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“…Recent studies demonstrated that not only the power setting, but also the contact force of the cathetertip is an important factor to predict tissue temperature, lesion depth, popping, and crater formation experimentally. [14][15][16] In the previous experiments, a 30W constant power and mean RF delivery duration of 105 ± 17 seconds resulted in a mean maximum catheter-tip temperature of 42 ± 5°C, mean lesion volume of 514 ± 104 mm 3 , and mean lesion depth of 8.2 ± 1.2 mm. We observed popping in 1 out of 6 cooled-ablations.…”

Section: Discussionmentioning

confidence: 99%

“…The contact force of the catheter-tip also affects steam pop and thrombus formation in an open-irrigated ablation, therefore contact force also should be measured. [14][15][16] Conclusion: Temperature-controlled cooled-tip RFCA is feasible without "steam pop" and an abrupt rise in impedance using an RF generator that slowly increases the power to reach the preselected catheter-tip temperature.…”

Section: Discussionmentioning

confidence: 99%

Temperature-Controlled Cooled-Tip Radiofrequency Ablation in Left Ventricular Myocardium Avoidance of Steam Pop During Ablation

et al. 2010

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SummarySteam pop and intramural charring have been reported during cooled-tip radiofrequency catheter ablation (RFCA). We studied the feasibility of temperature-controlled cooled-tip RFCA in the canine heart.An internally cooled ablation catheter was inserted into the left ventricle. A custom-made radiofrequency (RF) generator capable of controlling the tip-temperature at the preset level by slow increases in the power was used. Temperature-controlled cooled-tip RF applications were performed at a target temperature of 40°C for 90 seconds. Acute study: Intramyocardial temperature was measured at the ablation site in 10 dogs by inserting a fluoroptic probe. Chronic study: Lesion depth and volume were measured in 5 dogs after 3 weeks of survival. In the acute study, no pop or abrupt impedance rise was observed. Maximum intramyocardial temperature was 72.4 ± 14.4°C at 2-4 mm above the endocardium. No coagulum formation, craters, or intramural charring were observed. Maximum lesion depth was 6.7 ± 1.5 mm, and lesion volume was 404 ± 219 mm 3 . In the chronic study, maximum lesion depth was 5.9 ± 1.1 mm, and lesion volume was 281 ± 210 mm 3 . Temperature controlled RFCA is feasible with a cooled-tip catheter and an RF generator that slowly increases the RF power until the preset catheter-tip temperature is reached. (Int Heart J 2010; 51: 193-198)

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Relationship Between Catheter Forces, Lesion Characteristics, “Popping,” and Char Formation: Experience with Robotic Navigation System

Abstract: When using an OIC, lower power settings (

Cited by 147 publications

References 22 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

ThermoCool® SmartTouch® Catheter – The Evidence So Far for Contact Force Technology and the Role of VisiTag™ Module

Temperature-Controlled Cooled-Tip Radiofrequency Ablation in Left Ventricular Myocardium Avoidance of Steam Pop During Ablation

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