Failure Mechanisms in Off-Label Electrosurgery Devices for BASILICA, LAMPOON, and SESAME
Jaime L Murray1, Andre R Montes1, Andrea E Jaimes1
1Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
JACC. Cardiovascular Interventions
|June 22, 2026
Summary
Off-label transcatheter electrosurgery with metallic catheters can cause unintended heating and energy loss. Using nonmetallic catheters and short energy applications (≤2 seconds) significantly reduces these risks.
Area of Science:
- Cardiovascular Interventions
- Medical Device Engineering
- Electrosurgery
Background:
- Transcatheter electrosurgery using guidewire-catheter systems for tissue traversal or laceration carries risks of unexpected failure and nontarget heating.
- Off-label use of current systems necessitates understanding energy dynamics to improve safety.
Purpose of the Study:
- To identify mechanisms of energy loss and nontarget heating in off-label transcatheter electrosurgery systems.
- To evaluate factors influencing energy delivery and thermal effects during procedures like BASILICA, LAMPOON, and SESAME.
Main Methods:
- A 2-compartment benchtop model simulated electrosurgical traversal and flying-V laceration.
- Current distribution and regional heating were measured using metallic-braided and nonmetallic catheter assemblies.
Main Results:
- Longer, higher power energy applications led to significant catheter shaft heating and energy diversion from targets, exacerbated by insulation damage.
- Shorter, lower power applications and nonmetallic catheters mitigated these adverse effects.
- In SESAME procedures, connecting the intracavitary limb of the flying-V to the generator reduced intramyocardial heating risk.
Conclusions:
- Metallic braiding in microcatheters can divert energy and cause clinically significant nontarget heating.
- Energy applications of ≤2 seconds largely avoided failure modes in benchtop simulations.
- Favoring nonmetallic catheters, employing short energy applications, and optimizing generator connections (e.g., in SESAME) can enhance safety and reliability. Purpose-built devices may further improve outcomes.