Duy T Nguyen1, Joshua D Moss2, Lijun Zheng1, Janice Huang1, Waseem Barham1, William H Sauer3. 1. Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado. 2. Section of Cardiac Electrophysiology, Division of Cardiology, University of Chicago, Chicago, Illinois. 3. Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado,. Electronic address: william.sauer@ucdenver.edu.
Abstract
BACKGROUND: Cardiac radiofrequency (RF) ablation is typically achieved using symmetric catheter tips, which may result in unintended heating adjacent to targeted tissue. Partial insulation may alter lesion geometry and prevent collateral heating. OBJECTIVE: The purpose of this study was to assess partially insulated focused ablation (PIFA). METHODS: Partial insulation using thermally conductive materials was applied to a 4-mm or 8-mm nonirrigated catheter and a 3.5-mm open-irrigated catheter. These PIFA tips, or their noninsulated counterparts, were applied to ex vivo viable bovine myocardium. Ablations were delivered at various powers and under temperature control. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with irrigated PIFA and assessing its protective effects on the pericardium. RESULTS: PIFA catheters exhibited different properties and produced asymmetric lesions compared with corresponding standard ablation catheters. Temperatures at 3- and 5-mm depths were higher for PIFA catheters, with a temperature increase measured at the catheter tip-tissue interface; however, in temperature control ablation, tip-tissue temperature increases did not limit power delivery. Furthermore, temperatures were lower on the insulated surface and were significantly higher on the noninsulated PIFA side. Impedance changes were significantly larger; more steam pops were observed with PIFA but were mitigated by external irrigation, a larger tip electrode, and use of more thermally conductive insulation. In contrast to standard ablation, open-irrigated PIFA created larger asymmetric lesions in vivo over porcine epicardium, without evidence of pericardial injury. CONCLUSION: PIFA ablation has different characteristics compared with symmetrically conductive ablation. Further research is needed to assess the clinical implications of insulated catheter ablation.
BACKGROUND: Cardiac radiofrequency (RF) ablation is typically achieved using symmetric catheter tips, which may result in unintended heating adjacent to targeted tissue. Partial insulation may alter lesion geometry and prevent collateral heating. OBJECTIVE: The purpose of this study was to assess partially insulated focused ablation (PIFA). METHODS: Partial insulation using thermally conductive materials was applied to a 4-mm or 8-mm nonirrigated catheter and a 3.5-mm open-irrigated catheter. These PIFA tips, or their noninsulated counterparts, were applied to ex vivo viable bovine myocardium. Ablations were delivered at various powers and under temperature control. Potential clinical applicability was evaluated in vivo by targeting porcine epicardium with irrigated PIFA and assessing its protective effects on the pericardium. RESULTS: PIFA catheters exhibited different properties and produced asymmetric lesions compared with corresponding standard ablation catheters. Temperatures at 3- and 5-mm depths were higher for PIFA catheters, with a temperature increase measured at the catheter tip-tissue interface; however, in temperature control ablation, tip-tissue temperature increases did not limit power delivery. Furthermore, temperatures were lower on the insulated surface and were significantly higher on the noninsulated PIFA side. Impedance changes were significantly larger; more steam pops were observed with PIFA but were mitigated by external irrigation, a larger tip electrode, and use of more thermally conductive insulation. In contrast to standard ablation, open-irrigated PIFA created larger asymmetric lesions in vivo over porcine epicardium, without evidence of pericardial injury. CONCLUSION: PIFA ablation has different characteristics compared with symmetrically conductive ablation. Further research is needed to assess the clinical implications of insulated catheter ablation.
Authors: Ammar M Killu; Niyada Naksuk; Faisal F Syed; Christopher V DeSimone; Prakriti Gaba; Chance Witt; Dorothy J Ladewig; Scott H Suddendorf; Joanne M Powers; Gaurav Satam; Zdeněk Stárek; Tomas Kara; Jiří Wolf; Pavel Leinveber; Michal Crha; Miroslav Novák; Charles J Bruce; Paul A Friedman; Samuel J Asirvatham Journal: J Interv Card Electrophysiol Date: 2018-07-14 Impact factor: 1.900