Effects of Electrocautery on Transvenous Lead Insulation Materials

Lim, Kiam Khiang; Reddy, Shantanu; Desai, Shrojal M.; Smelley, Matthew; Kim, Susan S.; Beshai, John F.; Lin, Albert; Burke, Martin C.; Knight, Bradley P.

doi:10.1111/j.1540-8167.2008.01342.x

Cited by 32 publications

(33 citation statements)

References 13 publications

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“…Lead insulation defects are a common cause for lead failure and as previously shown electrocautery, which is using higher power than CA can create insulation damage to leads …”

Section: Discussionmentioning

confidence: 99%

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Dinshaw¹,

Schäffer²,

Akbulak³

et al. 2019

Cardiovasc electrophysiol

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Introduction Long‐term efficacy and safety are uncertain in patients with cardiac implantable electronic devices (CIED) and transvenous leads (TVL) undergoing radiofrequency catheter ablation of atrial fibrillation (AF). Thus, we assessed the outcome of AF ablation in those patients during long‐term follow‐up using continuous atrial rhythm monitoring (CARM). Methods and Results A total of 190 patients (71.3 ± 10.7 years; 108 (56.8% men) were included in this study. At index procedure 81 (42.6%) patients presented with paroxysmal AF and 109 (57.4%) with persistent AF. The ablation strategy included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines, if appropriate. AF recurrences were assessed by CARM‐ and CIED‐related complications by device follow‐up. After a mean follow‐up of 55.4 ± 38.1 months, freedom of AF was found in 86 (61.4%) and clinical success defined as an AF burden less than or equal to 1% in 101 (72.1%) patients. Freedom of AF was reported in 74.6% and 51.9% (P = 0.006) and clinical success in 89.8% and 59.3% (P < 0.001) of patients with paroxysmal and persistent AF, respectively. In 3 of 408 (0.7%) ablation procedures, a TVL malfunction occurred within 90 days after catheter ablation. During long‐term follow‐up 9 (4.7%) patients showed lead dislodgement, 2 (1.1%) lead fracture, and 2 (1.1%) lead insulation defect not related to the ablation procedure. Conclusion Our findings using CARM demonstrate long‐term efficacy and safety of radiofrequency catheter ablation of AF in patients with CIED and TVL.

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“…Lead insulation defects are a common cause for lead failure and as previously shown electrocautery, which is using higher power than CA can create insulation damage to leads …”

Section: Discussionmentioning

confidence: 99%

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Dinshaw¹,

Schäffer²,

Akbulak³

et al. 2019

Cardiovasc electrophysiol

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“… CIED leads, on the other hand, may be mechanically dislodged if recently implanted or potentially damaged through close or direct contact with ablation energy source. Lead insulation has been shown to be damaged by the use of RF electrocautery . However, there are scarce data as to whether catheter ablation can significantly damage CIED leads through direct contact .…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency and Cryo‐Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Darrat

Agarwal

Morales

et al. 2016

Cardiovasc electrophysiol

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Introduction Medical societies and cardiac implantable electronic devices (CIED) manufacturers recommend avoiding close or direct contact between the body of transvenous leads and ablation catheters used to treat cardiac arrhythmias. These recommendations are made despite the lack of clinical studies. However, the target myocardium for successful ablation can be contiguous to CIED leads. Methods and Results We examine in vitro the effects of direct application of radiofrequency (RF) and cryo-ablation energy on the integrity and functionality of CIED leads (excluding the pacing electrodes and defibrillation coils). A saline bath was created to mimic the body milieu. CIED leads, including all commercially available lead insulation materials, were connected to a CIED pulse generator and placed in direct contact with ablation catheter in the tissue bath. RF and cryo-ablation energy were delivered under various conditions, including maximal ablation power, temperature and impedance via the RF generator. CIED lead functionality, reflective of conductor integrity, was evaluated through lead impedance monitoring during ablation. CIED leads were then visually inspected, and examined with optic and electron microscopy as per protocol. A total of 42 leads were studied. All leads showed absence of insulation damage at the site of ablation visually and with microscopy. Lead functionality was also preserved in all leads. Conclusion Catheter ablation in contact with CIED leads using radiofrequency or cryo-ablation in vitro did not affect lead body integrity and function despite aggressive ablation settings. It may be reasonable to perform ablation in contact with the body of CIED leads when clinically necessary.

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“…Given the polyurethane (PU55D) insulation melting point between 185 and 225°C, the PEAK PlasmaBlade TM can be safely used in direct contact with implanted hardware. Otherwise, lead insulation may be damaged during an IPG replacement procedure by using traditional electrodiathermy technology, and extension cables may be damaged by using scissors and scalpels [7].…”

Section: Methodsmentioning

confidence: 99%

Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBladeTM

2016

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Effects of Electrocautery on Transvenous Lead Insulation Materials

Cited by 32 publications

References 13 publications

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

Radiofrequency and Cryo‐Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBladeTM

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