Changes in Local Wall Thickness Correlate with Pathologic Lesion Size Following Radiofrequency Catheter Ablation: An Intracardiac Echocardiographic Imaging Study

Ren, Jian-Fang; Callans, David J.; Schwartzman, David; Michele, J B S John; Marchlinski, Francis E.

doi:10.1046/j.1540-8175.2001.00503.x

Cited by 52 publications

(44 citation statements)

References 3 publications

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“…One is that the tissue surface is altered because of initial RF current, making subsequent ablations more difficult to penetrate deep in the tissue. 16 A more plausible explanation is that creation of a nontransmural lesion results in edema. It has been reported that heart wall thickness can double after 1 minute of ablation because of tissue edema formation.…”

Section: Cf Parametersmentioning

confidence: 99%

“…It has been reported that heart wall thickness can double after 1 minute of ablation because of tissue edema formation. 16 Hence, a nontransmural first lesion may increase wall thickness, reducing the effect of tissue heating and making it difficult to achieve full transmurality with subsequent ablations. Therefore, the goal of any RF ablation should be to achieve transmurality with the first attempt.…”

Section: Cf Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Neužil

Reddy

Kautzner

et al. 2013

Circ: Arrhythmia and Electrophysiology

413

363

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Background-Pulmonary vein isolation is the most prevalent approach for catheter ablation of paroxysmal atrial fibrillation.Long-term success of the procedure is diminished by arrhythmia recurrences occurring predominantly because of reconnections in previously isolated pulmonary veins. The aim of the EFFICAS I multicenter study was to demonstrate the correlation between contact force (CF) parameters during initial procedure and the incidence of isolation gaps (gap) at 3-month follow-up. Method and Results-A radiofrequency ablation catheter with integrated CF sensor (TactiCath, Endosense, Geneva, Switzerland) was used to perform pulmonary vein isolation in 46 patients with paroxysmal atrial fibrillation. During the ablation procedure, the operator was blinded to CF information. At follow-up, an interventional diagnostic procedure was performed to assess gap location as correlated to index procedure ablation parameters. At follow-up, 65% (26/40) of patients showed ≥1 gaps. Ablations with minimum Force-Time Integral (FTI) <400 gs showed increased likelihood for reconnection (P<0.001). Reconnection correlated strongly with minimum CF (P<0.0001) and minimum FTI (P=0.0007) at the site of gap. Gap occurrence showed a strong trend with lower average CF and average FTI. CF and FTI are generally higher on the right side, although the left anterior segment presents a unique challenge to achieve stable position with good CF. Conclusions-Minimum

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Section: Cf Parametersmentioning

confidence: 99%

Section: Cf Parametersmentioning

confidence: 99%

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Neužil

Reddy

Kautzner

et al. 2013

Circ: Arrhythmia and Electrophysiology

413

363

View full text Add to dashboard Cite

show abstract

“…We have found this most useful in the ventricle, where the wall thickness allows for distinct identification of lesion formation and ablation efficacy. This has been validated in a dog model of healed infarction, with the appearance of significant echogenicity and swelling with effective lesions [20,21]. The appearance of microbubbles at the tissue surface may indicate superheating and allow the operator to decrease or discontinue power delivery and avoid steam pops [22••].…”

Section: Complicationsmentioning

confidence: 99%

Use of Imaging Techniques to Guide Catheter Ablation Procedures

Robinson

Hutchinson

2010

Curr Cardiol Rep

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Paralleling the growth in ablation of complex arrhythmias such as atrial fibrillation and ventricular tachycardia, advanced imaging technologies are becoming more commonplace in the care of the electrophysiology patients. Although intracardiac ultrasound remains the most commonly used imaging technique, advances in real-time MRI may change this in the future. We discuss the current use of intracardiac ultrasound, CT, including rotational angiography, MRI, with an emphasis on delayed-enhancement MRI, and positron emission tomography-CT in advanced ablation procedures. Image integration is emphasized and new technologies such as direct endoscopic visualization are discussed.

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“…ICE can also confirm good contact between the ablation electrode and the endocardium during ablation, which allows for optimal energy transfer [18], Lesion formation can be manifest by increased echogenicity and mural thickening [19]. On the other hand, overzealous ablation can cause excessive tissue heating, leading to intramyocardial steam formation and abrupt liberation (steam-pop).…”

Section: Ablation Catheter Contact and Lesion Formationmentioning

confidence: 99%

Integrated Imaging of Atrial Fibrillation in 2010

Banthia

Knight

Jacobson

2010

Curr Cardiovasc Imaging Rep

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Catheter ablation has become the treatment of choice for atrial fibrillation in symptomatic patients who are refractory to antiarrhythmic medication. The predominant mechanism for initiation of atrial fibrillation is electrical activity originating from the pulmonary veins. Most ablation strategies are centered on electrical isolation of pulmonary veins. To successfully perform this ablation and decrease complications such as pulmonary vein stenosis, atrioesophageal fistula formation, and tamponade, the left atrial and pulmonary vein anatomy must be well understood. Imaging techniques have rapidly evolved over the past several years to aid in accurate display of cardiac anatomy. Electrophysiologists must understand how to integrate these imaging tools and recognize the relative strengths and pitfalls of each tool. Intracardiac echocardiography, three-dimensional electroanatomical mapping, and CT or MRI are often integrated during the procedure. Newer technologies are also on the horizon to aid in even better understanding of anatomy and catheter navigation.

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Changes in Local Wall Thickness Correlate with Pathologic Lesion Size Following Radiofrequency Catheter Ablation: An Intracardiac Echocardiographic Imaging Study

Cited by 52 publications

References 3 publications

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Use of Imaging Techniques to Guide Catheter Ablation Procedures

Integrated Imaging of Atrial Fibrillation in 2010

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