The Yin and Yang of Convective Cooling in Radiofrequency Catheter Ablation

Haines, David E.

doi:10.1161/circep.111.968099

Cited by 6 publications

(3 citation statements)

References 24 publications

(18 reference statements)

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“…To date, energy titration during RFA is largely empiric, relying on measurable variables such as ablation time, catheter tip temperature, power (watts), and ablation system impedance. However, these variables do not consistently predict lesion formation or size, and the gold standard for lesion assessment remains indirect via demonstration of conduction block and/or arrhythmia noninducibility . Measurement of the contact‐force between the catheter tip and the endocardial tissue is under investigation as an additional parametric predictor of RFA lesion formation, but cannot confirm actual lesion formation .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Near Real‐Time Lesion Assessment During Radiofrequency Catheter Ablation in Humans Using Acoustic Radiation Force Impulse Imaging

Bahnson

Eyerly

Hollender

et al. 2014

Cardiovasc electrophysiol

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Background Visual confirmation of radiofrequency ablation (RFA) lesions during clinical cardiac ablation procedures could improve procedure efficacy, safety, and efficiency. It was previously shown that acoustic radiation force impulse (ARFI) imaging can identify RFA lesions in vitro and in vivo in an animal model. This is the “first-in-human” feasibility demonstration of intracardiac ARFI imaging of RFA lesions in patients undergoing catheter ablation for atrial flutter (AFL) or atrial fibrillation (AF). Methods and Results Patients scheduled for right atrial (RA) ablation for AFL or left atrial (LA) ablation for drug refractory AF were eligible for imaging. Diastole-gated intracardiac ARFI images were acquired using one of two equipment configurations: (1) a Siemens ACUSON S2000™ ultrasound scanner and 8/10Fr AcuNav™ ultrasound catheter, or (2) a CARTO 3™ integrated Siemens SC2000™ and 10Fr SoundStar™ ultrasound catheter. A total of 11 patients (AFL = 3; AF = 8) were imaged. ARFI images were acquired of ablation target regions, including the RA cavotricuspid isthmus (CTI), and the LA roof, pulmonary vein ostia, posterior wall, posterior mitral valve annulus, and the ridge between the pulmonary vein and LA appendage. ARFI images revealed increased relative myocardial stiffness at ablation catheter contact sites after RFA and at anatomical mapping-tagged RFA treatment sites. Conclusions ARFI images from a pilot group of patients undergoing catheter ablation for AFL and AF demonstrate the ability of this technique to identify intra-procedure RFA lesion formation. The results encourage further refinement of ARFI imaging clinical tools and continued investigation in larger clinical trials.

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Section: Introductionmentioning

confidence: 99%

Feasibility of Near Real‐Time Lesion Assessment During Radiofrequency Catheter Ablation in Humans Using Acoustic Radiation Force Impulse Imaging

Bahnson

Eyerly

Hollender

et al. 2014

Cardiovasc electrophysiol

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“…Predicting RFA lesion size, transmurality, and line contiguity based on delivery parameters, such as radiofrequency (RF) duration and power, has been unreliable because variable convective cooling from blood flow at the ablation site and the instability of the electrode-tissue contact in the beating heart significantly affect lesion formation. [2][3][4][5][6] Also, there is currently no widespread clinical imaging method to intraprocedurally visualize and evaluate RFA lesions. Reported rates of arrhythmia recurrence post-TCA are typically around 20%, and studies have attributed arrhythmia recurrence to incomplete lesions or electrical conduction through unablated gaps in isolation lines.…”

Section: Introductionmentioning

confidence: 99%

Contrast in Intracardiac Acoustic Radiation Force Impulse Images of Radiofrequency Ablation Lesions

et al. 2014

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We have previously shown that intracardiac acoustic radiation force impulse (ARFI) imaging visualizes tissue stiffness changes caused by radiofrequency ablation (RFA). The objectives of this in vivo study were to (1) quantify measured ARFI-induced displacements in RFA lesion and unablated myocardium and (2) calculate the lesion contrast (C) and contrast-to-noise ratio (CNR) in two-dimensional ARFI and conventional intracardiac echo images. In eight canine subjects, an ARFI imaging-electroanatomical mapping system was used to map right atrial ablation lesion sites and guide the acquisition of ARFI images at these sites before and after ablation. Readers of the ARFI images identified lesion sites with high sensitivity (90.2%) and specificity (94.3%) and the average measured ARFI-induced displacements were higher at unablated sites (11.23 ± 1.71 μm) than at ablated sites (6.06 ± 0.94 μm). The average lesion C (0.29 ± 0.33) and CNR (1.83 ± 1.75) were significantly higher for ARFI images than for spatially registered conventional B-mode images (C = −0.03 ± 0.28, CNR = 0.74 ± 0.68).

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“…In fact, part of the heat generated by resistive heating of the tissue is carried away from the ablation site by circulating blood and saline irrigation. An effective heat dispersion can consequently permit, at a similar coagulum and char formation risk, an increased power delivery resulting deeper and larger lesions in the tissue layers 17,18 …”

Section: Introductionmentioning

confidence: 99%

Comparison of ThermoCool® Surround Flow Catheter Versus ThermoCool® Catheter in Achieving Persistent Electrical Isolation of Pulmonary Veins: A Pilot Study

Bertaglia

Fassini

Anselmino

et al. 2012

Cardiovasc electrophysiol

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The Yin and Yang of Convective Cooling in Radiofrequency Catheter Ablation

Cited by 6 publications

References 24 publications

Feasibility of Near Real‐Time Lesion Assessment During Radiofrequency Catheter Ablation in Humans Using Acoustic Radiation Force Impulse Imaging

Feasibility of Near Real‐Time Lesion Assessment During Radiofrequency Catheter Ablation in Humans Using Acoustic Radiation Force Impulse Imaging

Contrast in Intracardiac Acoustic Radiation Force Impulse Images of Radiofrequency Ablation Lesions

Comparison of ThermoCool® Surround Flow Catheter Versus ThermoCool® Catheter in Achieving Persistent Electrical Isolation of Pulmonary Veins: A Pilot Study

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