The influence of electrode-tissue-coverage on RF lesion formation and local impedance: Insights from an ex vivo model.
lesion size
local impedance
radiofrequency ablation
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
16
07
2023
received:
02
06
2023
accepted:
11
08
2023
medline:
11
10
2023
pubmed:
24
8
2023
entrez:
24
8
2023
Statut:
ppublish
Résumé
The influence of power, duration and contact force (CF) on radiofrequency (RF) lesion formation is well known, whereas data on local impedance (LI) and electrode-tissue-coverage (ETC) is scarce. The objective was to investigate their effect on lesion formation in an ex vivo model. An ex vivo model was developed utilizing cross-sections of porcine heart preparations and a force-sensing, LI-measuring catheter. N = 72 lesion were created systematically varying ETC (minor/full), CF (1-5 g, 10-15 g, 20-25 g) and power (20 W, 30 W, 40 W, 50 W). In minor ETC, the distal tip of the catheter was in electric contact with the tissue, in full ETC the whole catheter tip was embedded within the tissue. Lesion size and all parameters were measured once per second (n = 3320). LI correlated strongly with lesion depth (r = -0.742 for ΔLI; r = 0.781 for %LI-drop). Lesions in full ETC were significantly wider and deeper compared to minor ETC (p < .001) and steam pops were more likely. Baseline LI, ΔLI, and %LI-drop were significantly higher in full ETC (p < .001). In lesions resulting in steam pops, baseline LI, and ΔLI were significantly higher. The influence of CF on lesion size was higher in minor ETC than in full ETC. ETC is a main determinant of lesion size and occurrence of steam pops. Baseline LI and LI-drop are useful surrogate parameters for real-time assessment of ETC and ΔLI correlates strongly with lesion size.
Sections du résumé
BACKGROUND
The influence of power, duration and contact force (CF) on radiofrequency (RF) lesion formation is well known, whereas data on local impedance (LI) and electrode-tissue-coverage (ETC) is scarce. The objective was to investigate their effect on lesion formation in an ex vivo model.
METHODS AND RESULTS
An ex vivo model was developed utilizing cross-sections of porcine heart preparations and a force-sensing, LI-measuring catheter. N = 72 lesion were created systematically varying ETC (minor/full), CF (1-5 g, 10-15 g, 20-25 g) and power (20 W, 30 W, 40 W, 50 W). In minor ETC, the distal tip of the catheter was in electric contact with the tissue, in full ETC the whole catheter tip was embedded within the tissue. Lesion size and all parameters were measured once per second (n = 3320). LI correlated strongly with lesion depth (r = -0.742 for ΔLI; r = 0.781 for %LI-drop). Lesions in full ETC were significantly wider and deeper compared to minor ETC (p < .001) and steam pops were more likely. Baseline LI, ΔLI, and %LI-drop were significantly higher in full ETC (p < .001). In lesions resulting in steam pops, baseline LI, and ΔLI were significantly higher. The influence of CF on lesion size was higher in minor ETC than in full ETC.
CONCLUSIONS
ETC is a main determinant of lesion size and occurrence of steam pops. Baseline LI and LI-drop are useful surrogate parameters for real-time assessment of ETC and ΔLI correlates strongly with lesion size.
Substances chimiques
Steam
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1170-1181Informations de copyright
© 2023 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.
Références
Nath S, DiMarco JP, Haines DE. Basic aspects of radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 1994;5:863-876.
Bourier F, Ramirez FD, Martin CA, et al. Impedance, power, and current in radiofrequency ablation: insights from technical, ex vivo, and clinical studies. J Cardiovasc Electrophysiol. 2020;31:2836-2845.
Alken FA, Scherschel K, Kahle AK, Masjedi M, Meyer C. Combined contact force and local impedance dynamics during repeat atrial fibrillation catheter ablation. Front Physiol. 2022;13:1001719.
Kautzner J, Neuzil P, Lambert H, et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace. 2015;17:1229-1235.
Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation. EP Europace. 2022;24:874-886.
Bhaskaran A, Barry MA, Pouliopoulos J, et al. Circuit impedance could be a crucial factor influencing radiofrequency ablation efficacy and safety: a myocardial phantom study of the problem and its correction. J Cardiovasc Electrophysiol. 2016;27:351-357.
Chinitz J, Michaud G, Stephenson K. Impedance-guided radiofrequency ablation: using impedance to improve ablation outcomes. J Innov Card Rhythm Manag. 2017;8:2868-2873.
Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. EP Europace. 2016;19:775-783.
Hussein A, Das M, Riva S, et al. Use of ablation index-guided ablation results in high rates of durable pulmonary vein isolation and freedom from arrhythmia in persistent atrial fibrillation patients. Circ Arrhythm Electrophysiol. 2018;11:e006576.
Taghji P, El Haddad M, Phlips T, et al. Evaluation of a strategy aiming to enclose the pulmonary veins with contiguous and optimized radiofrequency lesions in paroxysmal atrial fibrillation. JACC Clin Electrophysiol. 2018;4:99-108.
Kanamori N, Kato T, Sakagami S, et al. Optimal lesion size index to prevent conduction gap during pulmonary vein isolation. J Cardiovasc Electrophysiol. 2018;29:1616-1623.
Mattia LD. Prospective evaluation of lesion index-guided pulmonary vein isolation technique in patients with paroxysmal atrial fibrillation: 1-year follow-up. J Atr Fibrillation. 2018;10:1858.
Chu GS, Calvert P, Futyma P, Ding WY, Snowdon R, Gupta D. Local impedance for the optimization of radiofrequency lesion delivery: a review of bench and clinical data. J Cardiovasc Electrophysiol. 2021;33(3):389-400.
Bourier F, Popa M, Kottmaier M, et al. RF electrode-tissue coverage significantly influences steam pop incidence and lesion size. J Cardiovasc Electrophysiol. 2021;32:1594-1599.
Nakagawa H, Wittkampf FHM, Yamanashi WS, et al. Inverse relationship between electrode size and lesion size during radiofrequency ablation with active electrode cooling. Circulation. 1998;98:458-465.
Shapira-Daniels A, Barkagan M, Rottmann M, et al. Modulating the baseline impedance. Circ Arrhythm Electrophysiol. 2019;12:e007336.
Matsuura G, Fukaya H, Ogawa E, et al. Catheter contact angle influences local impedance drop during radiofrequency catheter ablation: insight from a porcine experimental study with 2 different LI-sensing catheters. J Cardiovasc Electrophysiol. 2022;33:389-400.
Martin CA, Martin R, Gajendragadkar PR, et al. First clinical use of novel ablation catheter incorporating local impedance data. J Cardiovasc Electrophysiol. 2018;29:1197-1206.
Tsutsui K, Kawano D, Mori H, et al. Characteristics and optimal ablation settings of a novel, contact-force sensing and local impedance-enabled catheter in an ex vivo perfused swine ventricle model. J Cardiovasc Electrophysiol. 2021;32:3187-3194.
Iwakawa H, Takigawa M, Goya M, et al. Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study. J Interv Card Electrophysiol. 2021;63:185-195.
Kumar S, Haqqani HM, Chan M, et al. Predictive value of impedance changes for real-time contact force measurements during catheter ablation of atrial arrhythmias in humans. Heart Rhythm. 2013;10:962-969.
Tsutsui K, Kawano D, Mori H, et al. Characteristics and optimal ablation settings of a novel, contact-force sensing and local impedance-enabled catheter in an ex vivo perfused swine ventricle model. J Cardiovasc Electrophysiol. 2021;32:3187-3194.
Shah DC, Lambert H, Nakagawa H, Langenkamp A, Aeby N, Leo G. Area under the real-time contact force curve (force-time integral) predicts radiofrequency lesion size in an in vitro contractile model. J Cardiovasc Electrophysiol. 2010;21:1038-1043.
Takigawa M, Goya M, Iwakawa H, et al. Impact of a formula combining local impedance and conventional parameters on lesion size prediction. J Interv Card Electrophysiol. 2021;63:389-398.
Lacko CS, Chen Q, Mendoza V, et al. Development of a clinically relevant ex vivo model of cardiac ablation for testing of ablation catheters. J Cardiovasc Electrophysiol. 2023;34:682-692.