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Temperature-Controlled Radiofrequency Ablation Using Irrigated Catheters: Maximizing Ventricular Lesion Dimensions
Eran Leshem1, Israel Zilberman2, Michael Barkagan1
1Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Clinical Electrophysiology
|January 24, 2020
Summary
Radiofrequency ablation (RFA) using temperature control with novel irrigated catheters significantly reduces steam-pops. This advanced RFA technique allows for maximized lesion dimensions, enhancing ventricular ablation safety and efficacy.
Area of Science:
- Electrophysiology
- Cardiovascular Interventions
- Medical Device Technology
Background:
- Increasing radiofrequency ablation (RFA) dimensions carries a higher risk of steam-pops.
- A novel irrigated catheter with embedded circumferential thermocouples offers real-time surface temperature feedback.
- This study hypothesized that temperature-controlled RFA could maximize lesion dimensions while minimizing steam-pops.
Purpose of the Study:
- To evaluate the safety and efficacy of temperature-controlled radiofrequency ablation (RFA) using irrigated catheters for ventricular ablation.
- To determine if a novel irrigated catheter with surface thermocouples can reduce steam-pop occurrence during RFA.
- To compare lesion dimensions and steam-pop rates between temperature-controlled and power-controlled RFA modes.
Main Methods:
- Radiofrequency ablation (RFA) was performed using a novel irrigated catheter with surface thermocouples in swine thigh muscle and beating ventricles.
- Experiments utilized temperature-controlled settings (Tmax 50°C and 45°C) and compared them to power-controlled RFA.
- Biophysical properties, lesion dimensions, and steam-pop occurrences were analyzed across different RFA settings.
Main Results:
- Temperature-controlled RFA at Tmax 45°C demonstrated a significant reduction in steam-pops (0% in muscle, 7% in ventricle) compared to power-controlled RFA (82% in muscle, 37% in ventricle).
- Lesion depth and width were comparable across all tested RFA settings in both muscle and ventricular preparations.
- Half-normal saline did not enhance lesion dimensions at 50W in either preparation.
Conclusions:
- Radiofrequency ablation (RFA) with a novel irrigated catheter operated in a temperature-controlled mode effectively maximizes lesion dimensions.
- This temperature-controlled RFA approach significantly reduces the risk of steam-pops during ventricular ablation.
- The use of surface thermocouples in irrigated catheters enhances RFA safety and precision.
