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Guidewire Ablation within the Coronary Venous System for Epicardial or Intramural Ventricular Arrhythmia: A
Fengqi Xuan1,2, Zhongyin Zuo1, Jie Zhang1
1Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China.
Insights
Guidewire ablation in the coronary venous system (CVS) offers a promising solution for ventricular arrhythmias (VA) when catheter ablation fails. This technique safely creates effective lesions, potentially improving treatment outcomes for difficult VA cases.
Area of Science:
- Electrophysiology
- Cardiovascular Interventions
- Medical Device Technology
Background:
- Catheter ablation failure for epicardial or intramural ventricular arrhythmia (VA) presents a significant clinical challenge.
- Alternative strategies are needed to effectively target complex VA origins.
Purpose of the Study:
- To evaluate the safety and efficacy of guidewire ablation within the coronary venous system (CVS) for treating ventricular arrhythmias (VA).
- To determine optimal parameters for guidewire ablation in the CVS.
Main Methods:
- Ex vivo analysis of steam pop incidence and lesion size at various power settings and durations using 10 mm- and 20 mm-tip guidewires.
- Assessment of saline infusion effects on lesion dimensions and steam pop formation.
- In vivo study in dogs to evaluate lesion characteristics 10 days post-ablation.
Main Results:
- The 20 mm-tip guidewire demonstrated a lower incidence of steam pops compared to the 10 mm-tip guidewire at higher power settings.
- Lesion size increased with ablation duration, with optimal parameters identified for the 20 mm-tip guidewire (e.g., 15 W, 50 s, 2 mL/min).
- In vivo studies confirmed the creation of effective ablation lesions within the CVS.
Conclusions:
- Radiofrequency guidewire ablation is a feasible technique for creating effective lesions within the CVS.
- This novel approach holds potential for improving the efficacy of catheter ablation in managing challenging epicardial or intramural VA.
Background:
Catheter ablation failure poses a clinical challenge for epicardial or intramural ventricular arrhythmia (VA); however, guidewire ablation within the coronary venous system (CVS) may be effective and safe for targeting VAs.
Methods:
The ex vivo phase included four steps. In step 1, the steam pop incidence rates during guidewire ablation at power settings of 5, 10, 15, 20, and 25 W were analyzed using 10 mm- and 20 mm-tip guidewires. In step 2, guidewire ablation was performed for application durations of 10, 20, 30, 40, 50, 60, and 90 s, and the lesion size was measured. In step 3, the effects of saline infusion (0, 1, 2, 3, and 4 mL/min) on lesion dimensions and steam pop formation were examined. In step 4, an orthogonal array was constructed to obtain the optimal guidewire ablation parameters. In the in vivo phase, guidewire ablation within the CVS was performed in three dogs, and the lesion features in 10 days after ablation were observed.
Results:
In step 1, the steam pop incidence rates at 5, 10, 15, 20, and 25 W were 0%, 0%, 12.5%, 62.5%, and 100% using the 10 mm-tip guidewires and 0%, 0%, 0%, 25%, and 75% using the 20 mm-tip guidewires, respectively. In step 2, we found that the lesion areas increased with an increase in the ablation duration (the maximum lesion diameters at 30, 60, and 90 s were 4.9 ± 0.4, 7.0 ± 0.8, and 9.2 ± 0.7 mm in the 10 mm group and 3.2 ± 0.5, 4.5 ± 0.4, and 5.3 ± 0.7 mm in the 20 mm-tip group, respectively). In step 3, we observed that saline infusion was negatively correlated with ablation lesions but had a lower risk of steam pop. The optimal parameters for the 20 mm-tip guidewire ablation were 15 W, 50 s, and 2 mL/min or 20 W, 70 s, and 2 mL/min. In the in vivo phase, effective ablation lesions with maximum and minimum diameters of 3.2 ± 0.3 and 2.8 ± 0.5 mm, respectively, were created by the guidewires during the 10-day observation period after ablation.
Conclusion:
This novel radiofrequency guidewire ablation technique can feasibly create effective lesions within the CVS, which may improve the efficacy of catheter ablation for challenging epicardial or intramural VA.
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