Effect of Irrigant Characteristics on Lesion Formation After Radiofrequency Energy Delivery Using Ablation Catheters with Actively Cooled Tips
Irrigation Characteristics and Ablation Lesions Background The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both ope...
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Published in | Journal of cardiovascular electrophysiology Vol. 26; no. 7; pp. 792 - 798 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Blackwell Publishing Ltd
01.07.2015
Wiley Subscription Services, Inc |
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Abstract | Irrigation Characteristics and Ablation Lesions
Background
The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both open and closed irrigated catheter.
Methods
An ex vivo model consisting of viable bovine myocardium and a submersible load cell was assembled in a circulating saline bath at 37 °C. An externally irrigated ablation catheter and a closed irrigated catheter were positioned with 10 g of force in both perpendicular and parallel positions. A series of ablation lesions using different irrigants were delivered using a constant rate of irrigation (30 cc/min) at 50 W. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with different irrigants during open irrigation ablation and assessing lesion sizes.
Results
Ablation in the perpendicular position produced significantly larger lesions for all irrigants, compared to their respective parallel position ablation. For both open and closed irrigated ablation, half normal saline (HNS) ablation created larger lesions than normal saline (NS), and dextrose water (D5W) lesions were significantly larger than both HNS and NS lesions. Steam pops were mostly observed in the perpendicular position, and the rate of steam pops was statistically higher only for open irrigated D5W, but not for HNS, when compared to NS. Both open and closed irrigated ablation with D5W and HNS in the parallel position created larger lesions than parallel NS ablation without causing more steam pops. In an in vivo porcine model, open irrigated ablation with D5W created larger lesions compared to standard NS irrigation.
Conclusions
In ex vivo and in vivo models, decreased osmolarity and charge density increased RF energy delivery to tissue, resulting in larger lesions for both open and closed irrigated ablations. A perpendicular catheter position created larger lesions across all irrigants for both open and closed irrigation ablation. The incidence of steam pops was observed more frequently with high power open irrigated using D5W, especially if the catheter was in a perpendicular position. Further research is required to evaluate any clinical role for using different irrigants with an externally irrigated catheter. |
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AbstractList | Irrigation Characteristics and Ablation Lesions
Background
The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both open and closed irrigated catheter.
Methods
An ex vivo model consisting of viable bovine myocardium and a submersible load cell was assembled in a circulating saline bath at 37 °C. An externally irrigated ablation catheter and a closed irrigated catheter were positioned with 10 g of force in both perpendicular and parallel positions. A series of ablation lesions using different irrigants were delivered using a constant rate of irrigation (30 cc/min) at 50 W. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with different irrigants during open irrigation ablation and assessing lesion sizes.
Results
Ablation in the perpendicular position produced significantly larger lesions for all irrigants, compared to their respective parallel position ablation. For both open and closed irrigated ablation, half normal saline (HNS) ablation created larger lesions than normal saline (NS), and dextrose water (D5W) lesions were significantly larger than both HNS and NS lesions. Steam pops were mostly observed in the perpendicular position, and the rate of steam pops was statistically higher only for open irrigated D5W, but not for HNS, when compared to NS. Both open and closed irrigated ablation with D5W and HNS in the parallel position created larger lesions than parallel NS ablation without causing more steam pops. In an in vivo porcine model, open irrigated ablation with D5W created larger lesions compared to standard NS irrigation.
Conclusions
In ex vivo and in vivo models, decreased osmolarity and charge density increased RF energy delivery to tissue, resulting in larger lesions for both open and closed irrigated ablations. A perpendicular catheter position created larger lesions across all irrigants for both open and closed irrigation ablation. The incidence of steam pops was observed more frequently with high power open irrigated using D5W, especially if the catheter was in a perpendicular position. Further research is required to evaluate any clinical role for using different irrigants with an externally irrigated catheter. Irrigation Characteristics and Ablation Lesions Background The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both open and closed irrigated catheter. Methods An ex vivo model consisting of viable bovine myocardium and a submersible load cell was assembled in a circulating saline bath at 37 °C. An externally irrigated ablation catheter and a closed irrigated catheter were positioned with 10 g of force in both perpendicular and parallel positions. A series of ablation lesions using different irrigants were delivered using a constant rate of irrigation (30 cc/min) at 50 W. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with different irrigants during open irrigation ablation and assessing lesion sizes. Results Ablation in the perpendicular position produced significantly larger lesions for all irrigants, compared to their respective parallel position ablation. For both open and closed irrigated ablation, half normal saline (HNS) ablation created larger lesions than normal saline (NS), and dextrose water (D5W) lesions were significantly larger than both HNS and NS lesions. Steam pops were mostly observed in the perpendicular position, and the rate of steam pops was statistically higher only for open irrigated D5W, but not for HNS, when compared to NS. Both open and closed irrigated ablation with D5W and HNS in the parallel position created larger lesions than parallel NS ablation without causing more steam pops. In an in vivo porcine model, open irrigated ablation with D5W created larger lesions compared to standard NS irrigation. Conclusions In ex vivo and in vivo models, decreased osmolarity and charge density increased RF energy delivery to tissue, resulting in larger lesions for both open and closed irrigated ablations. A perpendicular catheter position created larger lesions across all irrigants for both open and closed irrigation ablation. The incidence of steam pops was observed more frequently with high power open irrigated using D5W, especially if the catheter was in a perpendicular position. Further research is required to evaluate any clinical role for using different irrigants with an externally irrigated catheter. BACKGROUNDThe delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both open and closed irrigated catheter.METHODSAn ex vivo model consisting of viable bovine myocardium and a submersible load cell was assembled in a circulating saline bath at 37°C. An externally irrigated ablation catheter and a closed irrigated catheter were positioned with 10 g of force in both perpendicular and parallel positions. A series of ablation lesions using different irrigants were delivered using a constant rate of irrigation (30 cc/min) at 50 W. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with different irrigants during open irrigation ablation and assessing lesion sizes.RESULTSAblation in the perpendicular position produced significantly larger lesions for all irrigants, compared to their respective parallel position ablation. For both open and closed irrigated ablation, half normal saline (HNS) ablation created larger lesions than normal saline (NS), and dextrose water (D5W) lesions were significantly larger than both HNS and NS lesions. Steam pops were mostly observed in the perpendicular position, and the rate of steam pops was statistically higher only for open irrigated D5W, but not for HNS, when compared to NS. Both open and closed irrigated ablation with D5W and HNS in the parallel position created larger lesions than parallel NS ablation without causing more steam pops. In an in vivo porcine model, open irrigated ablation with D5W created larger lesions compared to standard NS irrigation.CONCLUSIONSIn ex vivo and in vivo models, decreased osmolarity and charge density increased RF energy delivery to tissue, resulting in larger lesions for both open and closed irrigated ablations. A perpendicular catheter position created larger lesions across all irrigants for both open and closed irrigation ablation. The incidence of steam pops was observed more frequently with high power open irrigated using D5W, especially if the catheter was in a perpendicular position. Further research is required to evaluate any clinical role for using different irrigants with an externally irrigated catheter. The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to characterize lesion formation characteristics using different irrigants in both open and closed irrigated catheter. An ex vivo model consisting of viable bovine myocardium and a submersible load cell was assembled in a circulating saline bath at 37°C. An externally irrigated ablation catheter and a closed irrigated catheter were positioned with 10 g of force in both perpendicular and parallel positions. A series of ablation lesions using different irrigants were delivered using a constant rate of irrigation (30 cc/min) at 50 W. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with different irrigants during open irrigation ablation and assessing lesion sizes. Ablation in the perpendicular position produced significantly larger lesions for all irrigants, compared to their respective parallel position ablation. For both open and closed irrigated ablation, half normal saline (HNS) ablation created larger lesions than normal saline (NS), and dextrose water (D5W) lesions were significantly larger than both HNS and NS lesions. Steam pops were mostly observed in the perpendicular position, and the rate of steam pops was statistically higher only for open irrigated D5W, but not for HNS, when compared to NS. Both open and closed irrigated ablation with D5W and HNS in the parallel position created larger lesions than parallel NS ablation without causing more steam pops. In an in vivo porcine model, open irrigated ablation with D5W created larger lesions compared to standard NS irrigation. In ex vivo and in vivo models, decreased osmolarity and charge density increased RF energy delivery to tissue, resulting in larger lesions for both open and closed irrigated ablations. A perpendicular catheter position created larger lesions across all irrigants for both open and closed irrigation ablation. The incidence of steam pops was observed more frequently with high power open irrigated using D5W, especially if the catheter was in a perpendicular position. Further research is required to evaluate any clinical role for using different irrigants with an externally irrigated catheter. |
Author | OLSON, MATTHEW SAUER, WILLIAM H. BARHAM, WASEEM NGUYEN, DUY T. MOSS, JOSHUA D. ZHENG, LIJUN |
Author_xml | – sequence: 1 givenname: DUY T. surname: NGUYEN fullname: NGUYEN, DUY T. email: william.sauer@ucdenver.edu organization: University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Colorado, Aurora, USA – sequence: 2 givenname: MATTHEW surname: OLSON fullname: OLSON, MATTHEW organization: University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Colorado, Aurora, USA – sequence: 3 givenname: LIJUN surname: ZHENG fullname: ZHENG, LIJUN organization: University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Colorado, Aurora, USA – sequence: 4 givenname: WASEEM surname: BARHAM fullname: BARHAM, WASEEM organization: University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Colorado, Aurora, USA – sequence: 5 givenname: JOSHUA D. surname: MOSS fullname: MOSS, JOSHUA D. organization: University of Chicago, Division of Cardiology, Illinois, Chicago, USA – sequence: 6 givenname: WILLIAM H. surname: SAUER fullname: SAUER, WILLIAM H. organization: University of Colorado, Section of Cardiac Electrophysiology, Division of Cardiology, Colorado, Aurora, USA |
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Keywords | experimental study catheter ablation Smart Touch catheter contact force ventricular tachycardia irrigated catheter tip |
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Notes | ark:/67375/WNG-23KS2CDQ-P istex:CD78B65E7F384C681360B7D96FCBCDED999B7609 ArticleID:JCE12682 Dr. Sauer receives significant research grants from Biosense Webster and educational grants from St Jude Medical, Boston Scientific, and Medtronic. He has a provisional patent on partially insulated focused ablation. Other authors: No disclosures. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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References_xml | – volume: 25 start-page: 1391 year: 2014 end-page: 1399 article-title: Morphological and thermodynamic comparison of the lesions created by 4 open‐irrigated catheters in 2 experimental models publication-title: J Cardiovasc Electrophysiol – volume: 25 start-page: 463 year: 2002 end-page: 469 article-title: Radiofrequency catheter ablation using cooled electrodes: Impact of irrigation flow rate and catheter contact pressure on lesion dimensions publication-title: Pacing Clin Electrophysiol – volume: 25 start-page: 1219 year: 2002 end-page: 1222 article-title: Soft thrombus formation in radiofrequency catheter ablation publication-title: Pacing Clin Electrophysiol – volume: 5 start-page: 377 year: 2001 end-page: 389 article-title: Biophysics of radiofrequency ablation using an irrigated electrode publication-title: J Interv Card Electrophysiol – volume: 12 start-page: 623 year: 2015 end-page: 630 article-title: Effects of radiofrequency energy delivered through partially insulated metallic catheter tips on myocardial tissue heating and ablation lesion characteristics publication-title: Heart Rhythm – volume: 4 start-page: 660 year: 2011 end-page: 666 article-title: Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias publication-title: Circ Arrhythm Electrophysiol – volume: 28 start-page: S106 issue: Suppl 1 year: 2005 end-page: 109 article-title: Incidence and prevention of cardiac tamponade complicating ablation for atrial fibrillation publication-title: Pacing Clin Electrophysiol – volume: 16 start-page: 1172 year: 2005 end-page: 1179 article-title: Outcomes after cardiac perforation during radiofrequency ablation of the atrium publication-title: J Cardiovasc Electrophysiol – volume: 82 start-page: 1034 year: 1990 end-page: 1038 article-title: Observations on electrode‐tissue interface temperature and effect on electrical impedance during radiofrequency ablation of ventricular myocardium publication-title: Circulation – volume: 113 start-page: 11 year: 2006 end-page: 19 article-title: Comparison of electrode cooling between internal and open irrigation in radiofrequency ablation lesion depth and incidence of thrombus and steam pop publication-title: Circulation – volume: 24 start-page: 1157 year: 2013 end-page: 1162 article-title: Effects of open‐irrigated radiofrequency ablation catheter design on lesion formation and complications: In vitro comparison of 6 different devices publication-title: J Cardiovasc Electrophysiol – volume: 91 start-page: 2264 year: 1995 end-page: 2273 article-title: Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline‐irrigated electrode versus temperature control in a canine thigh muscle preparation publication-title: Circulation – volume: 25 start-page: 1385 year: 2014 end-page: 1390 article-title: Carbon nanotube facilitation of myocardial ablation with radiofrequency energy publication-title: J Cardiovasc Electrophysiol – ident: e_1_2_7_2_1 doi: 10.1161/01.CIR.82.3.1034 – ident: e_1_2_7_12_1 doi: 10.1016/j.hrthm.2014.11.022 – ident: e_1_2_7_8_1 doi: 10.1161/CIRCEP.111.963413 – ident: e_1_2_7_11_1 doi: 10.1111/jce.12509 – ident: e_1_2_7_14_1 doi: 10.1111/jce.12528 – ident: e_1_2_7_3_1 doi: 10.1046/j.1460-9592.2002.01219.x – ident: e_1_2_7_4_1 doi: 10.1023/A:1013224110550 – ident: e_1_2_7_5_1 doi: 10.1046/j.1460-9592.2001.01261.x – ident: e_1_2_7_7_1 doi: 10.1046/j.1540-8167.2002.00764.x – ident: e_1_2_7_9_1 doi: 10.1111/j.1540-8167.2005.50135.x – ident: e_1_2_7_10_1 doi: 10.1111/j.1540-8159.2005.00062.x – ident: e_1_2_7_13_1 doi: 10.1111/jce.12175 – ident: e_1_2_7_6_1 doi: 10.1046/j.1460-9592.2002.00463.x |
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Snippet | Irrigation Characteristics and Ablation Lesions
Background
The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by... The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We sought to... Irrigation Characteristics and Ablation Lesions Background The delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by... BACKGROUNDThe delivery of radiofrequency (RF) energy through irrigated ablation catheters may be affected by irrigant osmolarity and by catheter position. We... |
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SubjectTerms | Animals Cardiac Catheterization - adverse effects Cardiac Catheterization - instrumentation Cardiac Catheters catheter ablation Catheter Ablation - adverse effects Catheter Ablation - instrumentation Cattle contact force Equipment Design experimental study Glucose - administration & dosage In Vitro Techniques irrigated catheter tip Osmolar Concentration Pericardium - pathology Smart Touch catheter Sodium Chloride - administration & dosage Steam Temperature Therapeutic Irrigation - adverse effects Therapeutic Irrigation - instrumentation ventricular tachycardia |
Title | Effect of Irrigant Characteristics on Lesion Formation After Radiofrequency Energy Delivery Using Ablation Catheters with Actively Cooled Tips |
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