Duy T Nguyen1, Matthew Zipse2, Ryan T Borne2, Lijun Zheng2, Wendy S Tzou2, William H Sauer2. 1. Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado. Electronic address: duy.t.nguyen@ucdenver.edu. 2. Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado.
Abstract
OBJECTIVES: Given a paucity of data, the aim of this study was to define predictors of steam pops (SPs) during open-irrigated radiofrequency ablation (RFA). BACKGROUND: SPs during RFA can lead to dire consequences, including perforation and stroke. METHODS: In an ex vivo bovine myocardium model, open-irrigated RFA was applied at 50 W for 60 s; intracardiac echocardiographic images for RFA with and without SPs was compared. Using an in vivo porcine model, open-irrigated RFA was applied at 50 W for 60 s, and RFA parameters of SPs were analyzed. A retrospective analysis was performed of recorded SPs during clinical ablation procedures over a 1-year period. RESULTS: For RFA SPs, there was 32% greater intracardiac echocardiographic tissue echogenicity than for RFA without SPs (p < 0.001). In addition, RFA SPs had more rapid increases of tissue echogenicity, particularly in the last 5 s before SPs. Compared with RFA without SPs, RFA SPs had larger impedance reductions (33.0 ± 16.0 Ω vs. 23.0 ± 10.8 Ω; p = 0.032). SPs were also associated with more rapid initial impedance reduction (1.40 Ω/s vs. 0.38 Ω/s for RFA without SPs; p = 0.001). Clinical SPs during ablation procedures had a significantly faster impedance reduction during the first 5 s of ablation compared with matched control ablations (15.7 ± 6.7 Ω vs. 8.1 ± 4.7 Ω; p < 0.0001). CONCLUSIONS: Certain echocardiographic and biophysical parameters during open-irrigated RFA are associated with increased SP risks. These include greater tissue echogenicity, larger total impedance reduction, rapid rate of initial impedance reduction, and rapid increase in tissue echogenicity.
OBJECTIVES: Given a paucity of data, the aim of this study was to define predictors of steam pops (SPs) during open-irrigated radiofrequency ablation (RFA). BACKGROUND:SPs during RFA can lead to dire consequences, including perforation and stroke. METHODS: In an ex vivo bovine myocardium model, open-irrigated RFA was applied at 50 W for 60 s; intracardiac echocardiographic images for RFA with and without SPs was compared. Using an in vivo porcine model, open-irrigated RFA was applied at 50 W for 60 s, and RFA parameters of SPs were analyzed. A retrospective analysis was performed of recorded SPs during clinical ablation procedures over a 1-year period. RESULTS: For RFA SPs, there was 32% greater intracardiac echocardiographic tissue echogenicity than for RFA without SPs (p < 0.001). In addition, RFA SPs had more rapid increases of tissue echogenicity, particularly in the last 5 s before SPs. Compared with RFA without SPs, RFA SPs had larger impedance reductions (33.0 ± 16.0 Ω vs. 23.0 ± 10.8 Ω; p = 0.032). SPs were also associated with more rapid initial impedance reduction (1.40 Ω/s vs. 0.38 Ω/s for RFA without SPs; p = 0.001). Clinical SPs during ablation procedures had a significantly faster impedance reduction during the first 5 s of ablation compared with matched control ablations (15.7 ± 6.7 Ω vs. 8.1 ± 4.7 Ω; p < 0.0001). CONCLUSIONS: Certain echocardiographic and biophysical parameters during open-irrigated RFA are associated with increased SP risks. These include greater tissue echogenicity, larger total impedance reduction, rapid rate of initial impedance reduction, and rapid increase in tissue echogenicity.
Authors: Albert J Rogers; Ryan T Borne; Grant Ho; William H Sauer; Paul J Wang; Sanjiv M Narayan; Lijun Zheng; Duy T Nguyen Journal: J Cardiovasc Electrophysiol Date: 2020-04-27
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