Steam pop during cavo-tricuspid isthmus ablation shown by intracardiac echocardiography

Santoro, Amato; Romano, Andrea; Lamberti, Filippo

doi:10.1016/j.jccase.2020.08.002

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…However, the delineation of the CTI is time‐consuming and requires an expert technique of ICE use, which sometimes fails to detect the SEP 2 . If a power‐controlled RF is delivered in the undetectable SEP, there is a risk for steam pops, which sometimes cause right atrial perforations 7,8 . Therefore, a reliable modality able to detect the SEP and provide a safety‐net such as a tissue‐temperature controlled ablation in an undetectable SEP is warranted.…”

Section: Discussionmentioning

confidence: 99%

“… 2 However, the delineation of the CTI is time‐consuming and requires an expert technique of ICE use, which sometimes fails to detect the SEP. 2 If a power‐controlled RF is delivered in the undetectable SEP, there is a risk for steam pops, which sometimes cause right atrial perforations. 7 , 8 Therefore, a reliable modality able to detect the SEP and provide a safety‐net such as a tissue‐temperature controlled ablation in an undetectable SEP is warranted. From our data, bull's eye temperature monitoring of the QDOT catheter would be useful for the detection of a SEP with a high sensitivity and specificity, and a temperature‐controlled CTI ablation with the QDOT MICRO catheter may also enable avoiding steam pops even in an undetected SEP. All lesions where a red‐bull sign was not observed were located at the SEP edge area.…”

Section: Discussionmentioning

confidence: 99%

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Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch

Hirata

Nagashima

Watanabe

et al. 2022

Journal of Arrhythmia

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Background A subeustachian pouch (SEP) often hinders the completion of a cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL) and sometimes causes steam‐pops during a power‐controlled ablation. We hypothesized that real‐time bull's‐eye monitoring of the catheter surface temperature might be useful to locate the SEP where the temperature can rise rapidly, and a temperature‐controlled ablation might avoid steam pops. This study aimed to demonstrate this hypothesis. Methods A temperature‐controlled CTI ablation with a QDOT MICRO™ catheter (n = 10) and a conventional power‐controlled CTI ablation (n = 10) were performed with an output power of 35 W. During the RF application, the bull's eye monitor for monitoring the catheter surface temperatures was assessed. A “red‐bull sign” was defined as an entire red‐colored bull's‐eye monitor, indicating that the catheter‐tip temperature of all 6 thermocouples rose rapidly over 47°C. Results In a total of 115 lesions (12 ± 3 per patient), a “red‐bull sign” was observed in 39 (33.9%) lesions where the RF output was reduced to 26 ± 8 W. All 39 “red‐bull sign” lesions corresponded to the location of the SEP as delineated by ICE before the ablation. The red‐bull sign accurately indicated the presence of a SEP with a sensitivity of 84.7% and specificity of 100%. Bidirectional block of the CTI was completed in all patients in either catheter group without any steam‐pops. Conclusion Real‐time surface temperature monitoring and a red‐bull sign might be useful to detect the SEP. A temperature‐controlled CTI ablation with the QDOT MICRO catheter might be safe for avoiding steam pops.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch

Hirata

Nagashima

Watanabe

et al. 2022

Journal of Arrhythmia

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“…A-fib recurrence within the first year after the operation is common and greatly associated with inadequate ablation [3]. Excessive ablation could lead to steam pop, a relatively infrequent (0.1% to 1.5%) but potentially severe complication [4,5]. Steam pop has been associated with embolic strokes, cardiac perforations, and ventricular septal defects.…”

Section: Introductionmentioning

confidence: 99%

Cardiac-Gated Spectroscopic Photoacoustic Imaging for Ablation-Induced Necrotic Lesion Visualization: In Vivo Demonstration in a Beating Heart

Gao¹,

Ashikaga

Suzuki

et al. 2022

Preprint

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Radiofrequency (RF) ablation is a minimally invasive therapy for heart arrhythmia including atrial fibrillation (A-fib) by creating lesions to isolate the heart from abnormal electrical signals using an electric current. However, conventional RF procedures do not involve intraoperative monitoring of the area and extent of ablation-induced necrosis, making the assessment of procedure completeness challenging. Previous studies have suggested that spectroscopic photoacoustic (sPA) imaging is capable of differentiating ablated tissue from its non-ablated counterpart based on their PA spectrum variation. Here, we aim to demonstrate the applicability of sPA imaging in an in vivo environment where the cardiac motion presents and introduce a framework for mapping the necrotic lesion based on cardiac-gated sPA imaging. We computed the degree of necrosis (necrotic extent, NE) by taking the fraction of the quantified ablated tissue contrast over the total contrast from both ablated and non-ablated tissues, visualizing it as continuous colormap to highlight the necrotic area and extent. To compensate the tissue motion during a cardiac cycle, we applied the cardiac-gating on sPA data based on the image similarity. The in vivo validation of the concept was conducted in a swine model. As a result, the ablation-induced necrotic lesion at the surface of a beating heart was depicted throughout a cardiac cycle through cardiac-gated sPA (CG-sPA) imaging. The measured necrotic region geometry across the entire cardiac cycle was 6.01 +/- 2.35 mm in width by 1.79 +/- 0.75 mm in depth, which was comparable to the gross pathology with 6.0 mm by 2.9 mm, respectively. The results suggest that the introduced CG-sPA imaging system has the great potential to be incorporated into clinical workflow to guide ablation procedures intraoperatively.

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Cardiac‐gated spectroscopic photoacoustic imaging for ablation‐induced necrotic lesion visualization

Gao,

Ashikaga,

Suzuki

et al. 2024

Journal of Biophotonics

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Radiofrequency (RF) ablation is a minimally invasive therapy for atrial fibrillation. Conventional RF procedures lack intraoperative monitoring of ablation‐induced necrosis, complicating assessment of completeness. While spectroscopic photoacoustic (sPA) imaging shows promise in distinguishing ablated tissue, multi‐spectral imaging is challenging in vivo due to low imaging quality caused by motion. Here, we introduce a cardiac‐gated sPA imaging (CG‐sPA) framework to enhance image quality using a motion‐gated averaging filter, relying on image similarity. Necrotic extent was calculated based on the ratio between spectral unmixed ablated tissue contrast and total tissue contrast, visualizing as a continuous color map to highlight necrotic area. The validation of the concept was conducted in both ex vivo and in vivo swine models. The ablation‐induced necrotic lesion was successfully detected throughout the cardiac cycle through CG‐sPA imaging. The results suggest the CG‐sPA imaging framework has great potential to be incorporated into clinical workflow to guide ablation procedures intraoperatively.

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Steam pop during cavo-tricuspid isthmus ablation shown by intracardiac echocardiography

Cited by 4 publications

References 7 publications

Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch

Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch

Cardiac-Gated Spectroscopic Photoacoustic Imaging for Ablation-Induced Necrotic Lesion Visualization: In Vivo Demonstration in a Beating Heart

Cardiac‐gated spectroscopic photoacoustic imaging for ablation‐induced necrotic lesion visualization

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