Duy T Nguyen1, Waseem Barham1, Joshua Moss2, Lijun Zheng1, Benjamin Shillinglaw1, Robert Quaife1, Wendy S Tzou1, William H Sauer3. 1. Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado. 2. Division of Cardiology, Section of Cardiac Electrophysiology, University of Chicago, Chicago, Illinois. 3. Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado. Electronic address: william.sauer@ucdenver.edu.
Abstract
OBJECTIVES: This study hypothesized that a metal already commonly used in medical procedures, gadolinium (Gd), will augment radiofrequency (RF) thermal injury and affect cardiac ablation lesions. BACKGROUND: Enhancement of RF ablation using metallic particles has been proposed for ablation of tumors. METHODS: A series of ablation lesions were delivered at variable power using an ex vivo model. Tissue temperatures and lesion characteristics were analyzed. Ablation in a porcine in vivo model after direct needle injection of the myocardium with Gd or after systemic administration of Gd encased in heat sensitive liposomes was also performed and compared to control values. RESULTS: Ablation after Gd infiltration of myocardial tissue resulted in significantly larger lesions at both low- and high-power settings. Larger impedance changes were observed during ablation of Gd-treated myocardium. In vivo ablation using a force-sensing irrigated tip catheter resulted in enhanced lesion sizes after Gd injection without a higher incidence of steam pops or perforation. Systemic administration of liposomal Gd with local release by RF heating did not result in larger ablation sizes. CONCLUSIONS: Gd can be used to enhance RF ablation lesions. In both ex vivo studies with a 4-mm ablation catheter under power control and in vivo findings with an irrigated tip catheter, ablation of myocardium infiltrated with Gd resulted in larger lesions, with altered RF electrical and thermal characteristics. More research is needed to refine the potential for Gd facilitation of RF ablation. The use of systemic heat-sensitive liposomes containing Gd with targeted release by RF heating did not affect lesion size.
OBJECTIVES: This study hypothesized that a metal already commonly used in medical procedures, gadolinium (Gd), will augment radiofrequency (RF) thermal injury and affect cardiac ablation lesions. BACKGROUND: Enhancement of RF ablation using metallic particles has been proposed for ablation of tumors. METHODS: A series of ablation lesions were delivered at variable power using an ex vivo model. Tissue temperatures and lesion characteristics were analyzed. Ablation in a porcine in vivo model after direct needle injection of the myocardium with Gd or after systemic administration of Gd encased in heat sensitive liposomes was also performed and compared to control values. RESULTS: Ablation after Gd infiltration of myocardial tissue resulted in significantly larger lesions at both low- and high-power settings. Larger impedance changes were observed during ablation of Gd-treated myocardium. In vivo ablation using a force-sensing irrigated tip catheter resulted in enhanced lesion sizes after Gd injection without a higher incidence of steam pops or perforation. Systemic administration of liposomal Gd with local release by RF heating did not result in larger ablation sizes. CONCLUSIONS:Gd can be used to enhance RF ablation lesions. In both ex vivo studies with a 4-mm ablation catheter under power control and in vivo findings with an irrigated tip catheter, ablation of myocardium infiltrated with Gd resulted in larger lesions, with altered RF electrical and thermal characteristics. More research is needed to refine the potential for Gd facilitation of RF ablation. The use of systemic heat-sensitive liposomes containing Gd with targeted release by RF heating did not affect lesion size.
Authors: Babak Nazer; David Giraud; Yan Zhao; Yue Qi; O'Neil Mason; Peter D Jones; Chris J Diederich; Edward P Gerstenfeld; Jonathan R Lindner Journal: Ultrasound Med Biol Date: 2020-10-20 Impact factor: 2.998