Comparison of ablation characteristics of three different radiofrequency applicators in renal sympathetic denervation

Abstract

Objective: Renal sympathetic denervation (RDN) is an alternative treatment for resistant hypertension (RH). This study aims to compare ablation effects using three radiofrequency applicators (i.e., balloonbased four electrodes, spiral and monopolar devices). Methods: An idealized three-dimensional model of the renal artery was established using COMSOL Multiphysics to mimic radiofrequency ablation (RFA). Radiofrequency (RF) energy was delivered to the tissue at the same simulation settings, i.e., 4, 6, and 8 W for 60 s, using the three abovementioned RF applicators. The temperature distribution in the tissue was calculated using the coupled electrical-thermal-fluid finite element method. Lesion borders were defined using 50 C isotherms. The maximum lesion depth, width, area, and circumferential coverage rate were compared among the three applicators at a blood flow of 0.4 m/s. Monopolar RF ablations in a renal artery phantom model were performed to validate the reliability of the simulation method. Results: The balloon-based system yields greater lesion depths and widths compared with spiral and monopolar denervation under the same power. The range of maximum lesion depth is 1.58-3.11 mm for balloon-based RDN, 0.90-1.81 mm for spiral RDN and 1.12-2.38 mm for monopolar RDN, at a power of 4-8 W. The corresponding ranges of maximum lesion width are 2.22-5.73, 1.48-3.54, and 1.93-5.31 mm, respectively, and the circumferential coverage rates of the renal artery are 41.43%-91.99%, 31.71%-66.23%, and 9.55%-23.06%, respectively. The average velocity after balloonbased, spiral, and monopolar RDN increases by 3, 5, and 1 cm/s, respectively. The validation of the computer model offered prediction errors are <5% in terms of temperature at different locations (i.e., 2, 4, and 8 mm). Conclusions: In terms of lesion size, balloon-based RDN appears to be the best option for the treatment of RH. However, the change in flow velocity in the arterial flow field suggests that its hemodynamic changes must be prioritized for investigating its safety. Although spiral catheter ablation yields the smallest lesion size and a significant change in flow velocity in the flow field, its coverage rate is larger than that of monopolar RDN; compared with balloon-based RDN, it did not obstruct most of the blood flow.

Effect of renal denervation for patients with isolated systolic hypertension: a systematic review and meta-analysis

“…[34] However, this finding was not found in other studies. [31] In the present study, the subgroup analysis of different RDN approaches was not performed because of the incomplete data. Therefore, future randomized controlled trials are needed to resolve this issue.…”

“…[30] Furthermore, the ultrasound catheter ablation enables full circumferential ablations. Fengler, et al [31] demonstrated that the Paradise ultrasound ablation catheter had a superior BP lowering effect than the Spyral radiofrequency ablation catheter (differences: -6.7 mmHg, P = 0.038). In this meta-analysis, the comparison of radiofrequency and ultrasound catheters was unable to conduct because of the inco-mplete data.…”