An optimized approach for increasing lesion size in temperature-controled setting using a catheter with a surface thermocouple and efficient irrigation

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Arrhythmia Pub Date : 2024-04-22 DOI:10.1002/joa3.13040

Masateru Takigawa MD, PhD, Junji Yamaguchi MD, PhD, Masahiko Goya MD, PhD, Hidehiro Iwakawa MD, PhD, Tasuku Yamamoto MD, PhD, Miki Amemiya MD, Takashi Ikenouchi MD, PhD, Miho Negishi MD, Iwanari Kawamura MD, PhD, Kentaro Goto MD, PhD, Takatoshi Shigeta MD, PhD, Takuro Nishimura MD, PhD, Tomomasa Takamiya MD, PhD, Susumu Tao MD, PhD, Katsuhiro Ohuchi PhD, Sayaka Suzuki DVM, Shinsuke Miyazaki MD, PhD, Tetsuo Sasano MD, PhD

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Abstract

Background

We explore an optimized approach for increasing lesion size using a novel ablation catheter with a surface thermocouple and efficient irrigation in a temperature-control setting.

Methods

We conducted radiofrequency applications at various power levels (35 W, 40 W, and 45 W), contact forces (CFs, 10 g/20 g), and durations (60 s/120 s/180 s) in perpendicular/parallel catheter orientations, with normal saline irrigation (NS-irrigation) and Half NS-irrigation (HNS-irrigation) in an ex-vivo model (Step 1). In addition, we performed applications (35 W/40 W/45 W for 60 s/120 s/180 s in NS-irrigation and 35 W/40 W for 60 s/120 s/180 s in HNS-irrigation) in four swine (Step 2), evaluating lesion characteristics and the occurrence of steam pops.

Results

In Step 1, out of 288 lesions, we observed 47 (16.3%) steam pops, with 13 in NS-irrigation and 34 in HNS-irrigation (p = .001). Although steam pops were mostly observed with the most aggressive setting (45 W/180 s, 54%) with NS-irrigation, they happened in less aggressive settings with HNS irrigation. Lesion size significantly increased with longer-duration ablation but not with HNS-irrigation. The optimal %impedance-drop cutoff to predict steam pops was 20% with a negative-predictive-value (NPV) = 95.1% including NS- and HNS-irrigation groups, and 22% with an NPV = 96.1% in NS-irrigation group. In Step 2, similar to the ex-vivo model, lesion size significantly increased with longer-duration ablation but not with HNS-irrigation. Steam pops were absent with NS-irrigation (0/35) even with the largest %impedance-drop reaching 31% at 45 W/180 s. All steam pops were observed with HNS-irrigation (6/21, 29%). The optimal %impedance-drop cutoff predicting steam pops was 24% with an NPV = 96.3% including both NS- and HNS-irrigation groups.

Conclusions

Rather than using HNS-irrigation, very long-duration of radiofrequency applications up to 45 W/180 s may be recommended to safely and effectively increase lesion dimensions using this catheter with NS-irrigation.

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使用带有表面热电偶的导管和高效灌溉，在温度可控的环境中增加病变面积的优化方法

我们探索了一种优化方法，利用带有表面热电偶的新型消融导管和温控环境下的高效灌注来增大病灶面积。我们在体内外模型（步骤 1）中，以不同的功率水平（35 W、40 W 和 45 W）、接触力（CFs，10 g/20 g）和持续时间（60 s/120 s/180 s），在垂直/平行导管方向、正常生理盐水灌注（NS-灌注）和半 NS-灌注（HNS-灌注）下进行了射频应用。此外，我们还在四头猪身上进行了应用（NS-灌流为 35 W/40 W/45 W，60 秒/120 秒/180 秒；HNS-灌流为 35 W/40 W，60 秒/120 秒/180 秒）（步骤 2），评估了病变特征和蒸汽爆裂的发生率。在步骤 1 中，288 个病变中，我们观察到 47 个（16.3%）蒸汽爆裂，其中 NS- 灌流 13 个，HNS-灌流 34 个（p = .001）。虽然蒸汽爆裂主要出现在 NS 冲洗的最激进设置（45 瓦/180 秒，54%）中，但在 HNS 冲洗的较不激进设置中也出现了蒸汽爆裂。消融时间越长，病灶面积越大，但 HNS 冲洗则不然。预测蒸汽爆裂的最佳阻抗下降临界值为 20%，负预测值 (NPV) = 95.1%，包括 NS 灌流组和 HNS 灌流组；NS 灌流组为 22%，负预测值 = 96.1%。在步骤 2 中，与体外模型类似，病灶大小随着消融时间的延长而明显增大，但 HNS-irigation 却没有。NS-灌注组（0/35）没有蒸汽爆裂，即使在 45 W/180 秒时最大阻抗下降率达到 31%。所有蒸汽爆裂都是在 HNS 灌溉下出现的（6/21，29%）。预测蒸汽爆裂的最佳阻抗下降率临界值为 24%，NPV = 96.3%，包括 NS- 和 HNS- 灌注组。与其使用 HNS- 灌注，不如使用该导管配合 NS- 灌注，推荐使用长达 45 W/180 s 的超长射频应用，以安全有效地增加病灶尺寸。

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