Techniques for reducing air bubble intrusion into the left atrium during radiofrequency catheter and cryoballoon ablation procedures: An ex vivo study with a high-resolution camera

Takami, Mitsuru; Fujiwara, Ryosuke; Kijima, Yasufumi; Nagoshi, Ryoji; Kozuki, Amane; Mochizuki, Yasuhide; Shibata, Hiroyuki; Nakano, Shinsuke; Fukuyama, Yoshikazu; Fujimoto, Daichi; Kakizaki, Satoru; Masuko, E; Kurimoto, H.; Kyo, Shokan; Miyata, Tomohiro; Shite, Junya

doi:10.1016/j.hrthm.2018.07.038

Cited by 14 publications

(17 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A previous paper showed that a circular mapping catheter with a complex shape was likely to induce air intrusion. 11 In addition, Kuwahara et al 10 reported that all patients with air embolism were in long apnea episodes and had been snoring during the CB ablation procedures, and thus the authors suggested that the negative intrathoracic pressure may have induced the air embolism.…”

Section: Discussionmentioning

confidence: 99%

“…The 7‐Fr circular mapping catheter is effective for locating the origins of arrhythmia or gaps at the ablation lines for PVI. While inserting this catheter, the included inserter is not used for the reduction of air intrusion . Finally, the 5‐Fr steerable diagnostic catheter is usually not placed at the LA during PVI.…”

Section: Methodsmentioning

confidence: 99%

“…While inserting this catheter, the included inserter is not used for the reduction of air intrusion. 11 Finally, the 5-Fr steerable diagnostic catheter is usually not placed at the LA during PVI. It was adopted as one index for examining the type of catheter that will draw air into the sheath in this study.…”

Section: Sheathsmentioning

confidence: 99%

See 2 more Smart Citations

Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study

Tsukahara

Oginosawa

Fujino

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction One cause of cerebral infarction during cryoballoon ablation is the entry of air into a sheath due to the use of inappropriate catheters. It is known that the left atrial pressure of patients with obstructive sleep apnea syndrome can be negative. However, the effects of catheter selection and negative pressure changes in the sheath on air intrusion are not yet well understood. The aim of this study was to evaluate how catheter selection and negative pressure changes affect air intrusion and to perform countermeasures for air intrusion. Methods and Results This experiment used siphon principle to create negative pressure in the sheath. Noncryoablation catheters (not designed exclusively for cryoballoon ablation) and cryoballoon catheters were investigated. Catheters were inserted into the sheath and then removed. Thereafter, the amount of air in the sheath was measured. For catheters producing significantly larger amounts of air intrusion, the catheters were inserted via a long sheath in the sheath (sheath‐in‐sheath technique) and the same procedures were repeated. We found that the amount of air intrusion through most of the noncryoablation catheters was significantly larger than that through cryoablation catheters. An increase in the magnitude of negative pressure in the sheath resulted in a proportional increase in air intrusion, but the sheath‐in‐sheath technique significantly reduced air intrusion. Conclusion The amount of air intrusion increased when using catheters with complicated tip shapes and thin outer diameters and when the magnitude of negative pressure in the sheath increased. The sheath‐in‐sheath technique may be an effective countermeasure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study

Tsukahara

Oginosawa

Fujino

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Left atrial (LA) catheter ablation of atrial fibrillation (AF) has a potential risk of cerebral embolisms during the ablation procedure 1 . Air bubble intrusion into the LA through transseptal sheaths is one of the reasons for cerebral embolic complications and usually occurs during inserting or exchanging catheters over transseptal sheaths and flushing the sheaths with heparinized saline 2–7 . Experimental studies have demonstrated that the use of multielectrode catheters with complex shapes and an inserter during insertion of catheters increased the amount of air intrusion 3,4,7 .…”

Section: Introductionmentioning

confidence: 99%

Effect of preventing air intrusion on silent strokes during atrial fibrillation ablation using a mini‐basket catheter

Nakamura

Sasaki

Take

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background Air bubble intrusion through transseptal sheaths during left atrial (LA) catheter ablation can cause cerebral embolisms, especially when using complex‐shape catheters. This study aimed to compare the incidence of silent cerebral events (SCEs) after atrial fibrillation (AF) catheter ablation using a mini‐basket catheter (IntellaMap Orion; Boston Scientific) between the following groups: group SP, strict prevention of LA air intrusion and group CP, conventional air intrusion prevention. Methods We enrolled 123 consecutive AF patients (group SP, n = 61 and group CP, n = 62) who underwent brain magnetic resonance imaging after a local‐impedance‐guided ablation using one mini‐basket catheter and one circular mapping catheter. The preventive strategy in group SP included (a) the insertion of the mini‐basket catheter into the transseptal sheaths in a container filled with heparinized saline and (b) no exchange of all catheters over the sheaths. Results SCEs were detected in 67 patients (54.5%), and the incidence of SCEs did not significantly differ between groups SP and CP (55.7% vs 53.2%; P = .780). A multivariate analysis demonstrated that an older age, non‐paroxysmal AF, and radiofrequency (RF) power output were independent positive predictors of SCEs (odds ratios: 1.079, 5.613, and 1.405; P = .005, <.001, and .012). On the follow‐up MR imaging, 83.5% of the SCEs in group SP and 87.7% in group CP disappeared (P = .398). Conclusions Strict prevention of LA air intrusion may have no additional effect for reducing the incidence of SCEs after local impedance‐guided AF ablation using a mini‐basket catheter. An older age, non‐paroxysmal AF, and high‐power RF applications may increase the risk of SCEs.

show abstract

“…Recently, Takami et al studied air bubble intrusion during catheter ablation as a result of different catheter manipulations (eg, catheter introduction or sheath flushing), using either RF or cryoablation. Because catheter manipulations are assumed for comparison between various ablation modalities, in this study, we focus on the gas generated by the IRE‐ablation.…”

Section: Introductionmentioning

confidence: 99%

In vitro analysis of the origin and characteristics of gaseous microemboli during catheter electroporation ablation

Groen

Stehouwer

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction Recent studies demonstrated that irreversible electroporation (IRE) ablation may be an alternative method for thermal ablation for pulmonary vein isolation. Development of gaseous microemboli during catheter ablation might lead to asymptomatic ischemic events and is therefore an important research topic. Gas formation during arcing with direct current catheter ablation has been studied in the past, however not for nonarcing IRE‐ablation. Objective The aim of the present study was to visualize, quantify, and characterize gas formation during nonarcing millisecond IRE‐pulses using a multielectrode circular catheter. Methods In vitro, gas formation during IRE‐pulses was studied using a high‐speed imaging, direct volume measurements, and a bubble counter. Gas formation was compared between cathodal and anodal IRE‐pulses and between a small and large catheter hoop diameter. Results High‐speed images showed the location and dynamics of gas formation during cathodal and anodal millisecond IRE‐pulses. The direct volume measurements demonstrated a significantly larger volume for cathodal than for anodal IRE‐pulses (P < .001), and no significant difference between small and large hoop diameters. A strong linear relationship was found between delivered charge and total gas volume (r = 0.99). Bubble counter measurements showed that cathodal IRE‐pulses produced more and larger gas bubbles than anodal IRE‐pulses. The ratio of total gas volume between cathodal and anodal IRE‐pulses is different as predicted from electrolysis theory. Conclusion In vitro, millisecond anodal IRE‐pulses produce significantly less and smaller gas bubbles than millisecond cathodal IRE‐pulses. In vivo experiments are required to investigate the clinical implication of these observations.

show abstract

Techniques for reducing air bubble intrusion into the left atrium during radiofrequency catheter and cryoballoon ablation procedures: An ex vivo study with a high-resolution camera

Cited by 14 publications

References 13 publications

Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study

Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study

Effect of preventing air intrusion on silent strokes during atrial fibrillation ablation using a mini‐basket catheter

In vitro analysis of the origin and characteristics of gaseous microemboli during catheter electroporation ablation

Contact Info

Product

Resources

About