The ABLA-BOX: An in Vitro Module of Hybrid Atrial Fibrillation Ablation

Lozekoot, Pieter; Jong, Monique M.J. de; Parise, Orlando; Matteucci, Francesco; Lucà, Fabiana; Kumar, Narendra; Bani, Danièle; Czapla, Jens; Pison, Laurent; Crijns, Harry J.G.M.; Meir, Mark La; Gelsomino, Sandro

doi:10.1097/imi.0000000000000256

Cited by 5 publications

(15 citation statements)

References 26 publications

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“…5,9,11,20 We chose porcine left ventricular myocardial tissue based on its similarity to human myocardium as reported in prior studies. 15,16,[18][19][20][21] Furthermore, porcine myocardium has closer conductivity to human cardiac tissue (8.3 and 8.9 mS/cm, respectively at 100 MHZ) compared to canine skeletal muscle (7.5-8.2 mS/cm at 100 MHz), 22 and it provides adequate thick- Tissue bath and irrigation conductivity were both constrained to 6.5 ± 0.1 mS/cm to maintain tissue bath conductivity throughout the ablation procedure within the range of human blood conductivity 23 and similar models in the literature. 20 Media temperature was set to 37°C to match physiologic temperatures and provide clinical correlation.…”

Section: Discussionmentioning

confidence: 99%

Development of a clinically relevant ex vivo model of cardiac ablation for testing of ablation catheters

Lacko¹,

Chen²,

Mendoza³

et al. 2022

Cardiovasc electrophysiol

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Introduction: Reliable ex vivo cardiac ablation models have the potential to increase catheter testing throughput while minimizing animal usage. The goal of this work was to develop a physiologically relevant ex vivo swine model of cardiac ablation displaying minimal variability and high repeatability and identify and optimize key parameters involved in ablation outcomes. Methods and Results:A root cause analysis was conducted to identify variables affecting ablation outcomes. Parameters associated with the tissue, bath media, and impedance were identified. Variables were defined experimentally and/or from literature sources to best mimic the clinical cardiac ablation setting. The model was validated by performing three independent replicates of ex vivo myocardial ablation and a direct comparison of lesion outcomes of the ex vivo swine myocardial and in vivo canine thigh preparation (TP) models. Replicate experiments on the ex vivo model demonstrated low variance in ablation depth (6.5 ± 0.6, 6.3 ± 0.6, 6.2 ± 0.4 mm) and width (10.4 ± 1.1, 9.7 ± 1.0, 9.9 ± 0.9 mm) and no significant differences between replicates. In a direct comparison of the two models, the ex vivo model demonstrated ablation depths similar to the canine TP model at 35 W (6.9 ± 1.0, and 7.0 ± 0.9 mm) and 50 W (8.0 ± 0.7, and 8.4 ± 0.7 mm), as well as similar power to depth ratios (15% and 19% for the ex vivo cardiac and in vivo TP models, respectively). Conclusion:The ex vivo model exhibited strong lesion reproducibility and power-todepth ratios comparable to the in vivo TP model. The optimized ex vivo model minimizes animal usage with increased throughput, lesion characteristics similar to the in vivo TP model, and ability to discriminate minor variations between different catheter designs.

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Section: Discussionmentioning

confidence: 99%

Development of a clinically relevant ex vivo model of cardiac ablation for testing of ablation catheters

Lacko¹,

Chen²,

Mendoza³

et al. 2022

Cardiovasc electrophysiol

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“…For the testing of the prototype, we used a previously described simulator (ABLA-BOX). 10 Briefly, it consists of a double chamber plexiglass box mimicking the left atrium with the separation between the 2 chambers representing the left atrial wall. Two rails are placed side by side externally to the box, and a catheter holder with a pressure sensor (AE Sensors, Dordrecht, The Netherlands) is mounted over both rails ( Fig.…”

Section: Methodsmentioning

confidence: 99%

New Biparietal Bipolar Catheter Prototype for Hybrid Atrial Fibrillation Ablation

Matteucci

Maesen

Asmundis

et al. 2021

Innovations�(Phila)

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Objective To evaluate the size and depth of linear lesions by in vitro testing with a custom-made radio frequency biparietal bipolar ablation catheter in a single-stage setting. Methods A custom-made catheter was created to generate linear lesions around the left atrium and pulmonary veins of an ex vivo pig. Two frames were made, 1 epicardial and 1 endocardial. A continuous copper braid electrode and an alignment system consisting of 2 parallel rows of neodymium magnets were embedded in a flexible plastic support. After 24 hours of formalin conservation, samples of the left atrium of a freshly slaughtered pig were sliced in a cryotome, thus obtaining a sequence of 100-µm thick layers extending from the endocardial to the epicardial side. After being digitized through a scanner, these layers were evaluated using morphometric computer software. For each slice, we evaluated the maximum length of the lesions, the maximum epicardial length, the maximum endocardial length, the total area of the lesion, and the total volume. Results Forty transmural lesions from 40 specimens were obtained. The results were the following (the number in parenthesis is the interquartile range in mm): lesion maximum length ( L MAX) was 7.297 mm (0.006), epicardial maximum length ( L EPI) was 7.291 mm (0.014), and endocardial maximum length was 7.291 mm (0.018). The total area and total volume were 1018.50 ± 36.51 mm2 and 101.85 ± 3.65 mm3, respectively. Conclusions Our prototype showed very promising results. The next step will be to enhance the design for clinical application.

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“…Based on our previous experiences, 12,14 the endocardial contact force was set up at 30 gr. From the epicardial side was chosen a 300 gr force as currently employed in surgery.…”

Section: Methodsmentioning

confidence: 99%

“…The ABLA-BOX simulator (IDEE-Instrument Development Engineering and Evaluation, Maastricht University, The Netherlands) has been previously described. 12 Briefly, the chamber mimicking the internal part of the left atrium has an inlet and outlet access plugged into an external pump (COBE precision blood pump, COBE Cardiovascular Inc, Arvada, CO, USA) for blood circulation ( Fig. 1a and b).…”

Section: The Simulatormentioning

confidence: 99%

One-Stage Versus Sequential Hybrid Radiofrequency Ablation: An In Vitro Evaluation

Matteucci

Maesen

Vernooy

et al. 2020

Innovations�(Phila)

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Objective To compare lesion size and depth between a 1-step, a sequential, and a delayed radio-frequency ablation in a hybrid setup. Methods Left atrium tissues obtained from fresh porcine hearts were mounted into the ABLABOX simulator. Based on the time differences between the index epicardial (epi) and consequent endocardial (endo) ablation, 3 study groups were compared: a 1-stage (SEQ- 0) group (0-minute delay), an SEQ 1 group (60-minute delay), and an SEQ 2 group (240-minute delay). During the experiment, a constant epicardial (300 gr) and endocardial (30 gr) force were applied. Per group, 20 samples were studied, and the resulting lesion size and depth were quantified with morphometric evaluation. Results Overall, no transmural lesion was obtained. Lesions in SEQ 0 had better maximum and minimum diameters ( P < 0.001), a larger total area ( P < 0.001), and volume ( P < 0.001) than SEQ 1 and SEQ 2. There was no statistical difference in morphometric parameters (all, P > 0.05) between the delayed procedures (SEQ 1 and SEQ 2). Conclusions In our in vitro model, different time sequences of combined epi–endo ablation did not result in transmural lesions. However, simultaneous epi–endo ablation produced broader and deeper lesions. Our findings need to be confirmed by further research.

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The ABLA-BOX: An in Vitro Module of Hybrid Atrial Fibrillation Ablation

Cited by 5 publications

References 26 publications

Development of a clinically relevant ex vivo model of cardiac ablation for testing of ablation catheters

Development of a clinically relevant ex vivo model of cardiac ablation for testing of ablation catheters

New Biparietal Bipolar Catheter Prototype for Hybrid Atrial Fibrillation Ablation

One-Stage Versus Sequential Hybrid Radiofrequency Ablation: An In Vitro Evaluation

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