Novel Irrigated Temperature-Controlled Lattice Ablation Catheter for Ventricular Ablation: A Preclinical Multimodality Biophysical Characterization.

Ayelet Shapira-Daniels, M. Barkagan, H. Yavin, J. Sroubek, V. Reddy, P. Neužil, E. Anter
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引用次数: 9

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.
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用于心室消融的新型温控灌洗点阵消融导管:临床前多模态生物物理表征。
背景:室性心动过速消融常因病变产生不足而受限。一种具有可膨胀晶格电极的新型射频导管具有更大的表面积,能够以更低的密度输送更高的电流,从而潜在地增加病变尺寸而不会过热。方法该8F双向冲洗导管(Sphere-9, Affera Inc .)具有9mm的球形点阵尖端(“点阵”),有效表面积比标准线性导管大10倍。九个表面热电偶提供温度反馈到一个专有的在温度控制模式下运行的大电流发电机。离体阶段:在11个牛心脏中,比较了晶格(Tmax60°C)和标准线性冲洗尖端导管(40 W)在接触力为10 g时30、60和120秒的单极消融。在5个猪心脏中,比较了导管的双极消融(Tmax60°C与40w;60秒)。体内阶段:在9头猪中,在Tmax60°C和40w下进行心室消融60秒。此外,在3和7毫米的组织深度直接组织温度被测量在大腿肌肉准备。结果:体内:晶格在30,60和120秒的应用时间内产生更深的病变(6.7±1.3 vs 4.8±1.2 mm;8.3±1.4 vs 5.4±0.8 mm;分别为10.0±1.6 mm和6.1±1.6 mm, P≤0.001)。双极病变更深(15.8±4.1对10.5±1.4 mm, P<0.001),更有可能是跨壁的(80%对0%,P=0.002)。体内:晶格产生更深的病变(10.5±1.4 vs 6.5±0.8 mm, P≤0.001)。7 mm处组织温度较高,为+15.1±2.4℃;P < 0.001)。蒸汽爆裂的发生率较晶格低(总数:4% vs 18%, P=0.02;体内0% vs 14.2%, P=0.13)。结论:与标准冲洗导管相比,这种新型射频系统可产生更大的心室损伤,且组织过热的风险更低。这可能提高室性心动过速消融手术的疗效,同时减少应用次数和手术时间。
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