Ayelet Shapira-Daniels1, Michael Barkagan1, Hagai Yavin1, Jakub Sroubek1, Vivek Y Reddy2,3, Petr Neuzil3, Elad Anter1. 1. Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S.-D., M.B., H.Y., J.S., E.A.). 2. Helmsley Center for Electrophysiology, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (V.Y.R.). 3. Department of Cardiology, Hamolka Hospital, Prague, Czech Republic (V.Y.R., P.N.).
Abstract
BACKGROUND: Ventricular tachycardia ablation is often limited by insufficient lesion creation. A novel radiofrequency catheter with an expandable lattice electrode has a larger surface area capable of delivering higher currents at a lower density to potentially increase lesion dimensions without overheating. METHODS: This 8F bidirectional irrigated catheter (Sphere-9, Affera Inc) has a 9 mm spherical lattice tip ("lattice") with an effective surface area 10-fold larger than standard linear catheters. Nine surface thermocouples provide temperature feedback to a proprietary high-current generator operating in a temperature-controlled mode. Ex vivo phase: in 11 bovine hearts, unipolar ablation at 30, 60, and 120 seconds was compared between the lattice (Tmax60°C) and a standard linear irrigated-tip catheter (40 W) at contact force of 10 g. In 5 porcine hearts, bipolar ablation was compared between the catheters (Tmax60°C versus 40 W; 60 seconds). In vivo phase: in 9 swine, ventricular ablation at Tmax60°C versus 40 W was performed for 60 seconds. In addition, direct tissue temperature at 3- and 7-mm tissue depth was measured in a thigh muscle preparation. RESULTS: Ex vivo: lattice produced deeper lesions at 30, 60, and 120 seconds application duration (6.7±1.3 versus 4.8±1.2 mm; 8.3±1.4 versus 5.4±0.8 mm; 10.0±1.6 versus 6.1±1.6 mm, respectively, P≤0.001 for all). Bipolar lesions were deeper (15.8±4.1 versus 10.5±1.4 mm, P<0.001) and more likely to be transmural (80% versus 0%, P=0.002). In vivo: lattice produced deeper lesions (10.5±1.4 versus 6.5±0.8 mm, P≤0.001). Tissue temperature at 7 mm was higher with the lattice (+15.1±2.4°C; P<0.001). The steam-pop occurrence was lower with the lattice (total: 4% versus 18%, P=0.02; in vivo 0% versus 14.2%, P=0.13). CONCLUSIONS: This novel radiofrequency system produces larger ventricular lesions compared with standard irrigated catheters and at a lower risk of tissue overheating. This may improve the efficacy of ventricular tachycardia ablation procedures while reducing the number of applications and procedural duration.
BACKGROUND:Ventricular tachycardia ablation is often limited by insufficient lesion creation. A novel radiofrequency catheter with an expandable lattice electrode has a larger surface area capable of delivering higher currents at a lower density to potentially increase lesion dimensions without overheating. METHODS: This 8F bidirectional irrigated catheter (Sphere-9, Affera Inc) has a 9 mm spherical lattice tip ("lattice") with an effective surface area 10-fold larger than standard linear catheters. Nine surface thermocouples provide temperature feedback to a proprietary high-current generator operating in a temperature-controlled mode. Ex vivo phase: in 11 bovine hearts, unipolar ablation at 30, 60, and 120 seconds was compared between the lattice (Tmax60°C) and a standard linear irrigated-tip catheter (40 W) at contact force of 10 g. In 5 porcine hearts, bipolar ablation was compared between the catheters (Tmax60°C versus 40 W; 60 seconds). In vivo phase: in 9 swine, ventricular ablation at Tmax60°C versus 40 W was performed for 60 seconds. In addition, direct tissue temperature at 3- and 7-mm tissue depth was measured in a thigh muscle preparation. RESULTS: Ex vivo: lattice produced deeper lesions at 30, 60, and 120 seconds application duration (6.7±1.3 versus 4.8±1.2 mm; 8.3±1.4 versus 5.4±0.8 mm; 10.0±1.6 versus 6.1±1.6 mm, respectively, P≤0.001 for all). Bipolar lesions were deeper (15.8±4.1 versus 10.5±1.4 mm, P<0.001) and more likely to be transmural (80% versus 0%, P=0.002). In vivo: lattice produced deeper lesions (10.5±1.4 versus 6.5±0.8 mm, P≤0.001). Tissue temperature at 7 mm was higher with the lattice (+15.1±2.4°C; P<0.001). The steam-pop occurrence was lower with the lattice (total: 4% versus 18%, P=0.02; in vivo 0% versus 14.2%, P=0.13). CONCLUSIONS: This novel radiofrequency system produces larger ventricular lesions compared with standard irrigated catheters and at a lower risk of tissue overheating. This may improve the efficacy of ventricular tachycardia ablation procedures while reducing the number of applications and procedural duration.
Entities:
Keywords:
ablation; catheter; electrodes; heart ventricle; radiofrequency; temperature
Authors: Ayelet Shapira-Daniels; Michael Barkagan; Markus Rottmann; Jakub Sroubek; Derin Tugal; Michael A Carlozzi; James W McConville; Alfred E Buxton; Elad Anter Journal: Circ Arrhythm Electrophysiol Date: 2019-06
Authors: Elad Anter; Andre G Kleber; Markus Rottmann; Eran Leshem; Michael Barkagan; Cory M Tschabrunn; Fernando M Contreras-Valdes; Alfred E Buxton Journal: JACC Clin Electrophysiol Date: 2018-06-27
Authors: Luigi Di Biase; J David Burkhardt; Dhanujaya Lakkireddy; Corrado Carbucicchio; Sanghamitra Mohanty; Prasant Mohanty; Chintan Trivedi; Pasquale Santangeli; Rong Bai; Giovanni Forleo; Rodney Horton; Shane Bailey; Javier Sanchez; Amin Al-Ahmad; Patrick Hranitzky; G Joseph Gallinghouse; Gemma Pelargonio; Richard H Hongo; Salwa Beheiry; Steven C Hao; Madhu Reddy; Antonio Rossillo; Sakis Themistoclakis; Antonio Dello Russo; Michela Casella; Claudio Tondo; Andrea Natale Journal: J Am Coll Cardiol Date: 2015-12-29 Impact factor: 24.094
Authors: Luigi Di Biase; Pasquale Santangeli; David J Burkhardt; Rong Bai; Prasant Mohanty; Corrado Carbucicchio; Antonio Dello Russo; Michela Casella; Sanghamitra Mohanty; Agnes Pump; Richard Hongo; Salwa Beheiry; Gemma Pelargonio; Pietro Santarelli; Martina Zucchetti; Rodney Horton; Javier E Sanchez; Claude S Elayi; Dhanunjay Lakkireddy; Claudio Tondo; Andrea Natale Journal: J Am Coll Cardiol Date: 2012-07-10 Impact factor: 24.094
Authors: Duy T Nguyen; Edward P Gerstenfeld; Wendy S Tzou; Paul T Jurgens; Lijun Zheng; Joseph Schuller; Matthew Zipse; William H Sauer Journal: JACC Clin Electrophysiol Date: 2017-05-30
Authors: Jacob S Koruth; Srinivas Dukkipati; Marc A Miller; Petr Neuzil; Andre d'Avila; Vivek Y Reddy Journal: Heart Rhythm Date: 2012-08-02 Impact factor: 6.343