History of transcatheter atrial fibrillation ablation

Anselmino, Matteo; D’Ascenzo, Fabrizio; Amoroso, G; Ferraris, Federico; Gaïta, Fiorenzo

doi:10.2459/jcm.0b013e32834ead59

Cited by 14 publications

(2 citation statements)

References 66 publications

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“…Today cryoablation is a procedure used in various medical therapies on patients suffering for example from cancer or atrial fibrillation [7][8][9] and a deep knowledge of the tissues response to this freezing could increase the success rate by reducing recurrences. The cooling dynamics (i.e.…”

Section: Introductionmentioning

confidence: 99%

Experimental Investigation on Thermal Conductivity and Thermal Diffusivity of Water-Agar Gel from Room Temperature to –60℃

Campagnoli¹,

Giaretto²

2020

IJHT

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From a thermal point of view, water-agar gel can reproduce the behavior of human soft tissues with a good approximation. For this reason, agar gel is widely used to mimic the thermal diffusion inside the latter, in order to study the effect on human tissues of new techniques and probes used to solve various health diseases. Cryoablation is part of these techniques and its effectiveness strongly depends on the biological response of the tissues to the freezing action and heat diffusion and therefore on their thermo-physical properties. This study presents the values of thermal conductivity and thermal diffusivity, measured on water-agar gel samples, using the transient plane source method, forward and backward from room temperature down to −60℃. The freezing transient and the temperature at which the phase transition begins are highlighted, as well as the temperature dependence of both thermal conductivity and diffusivity.

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Section: Introductionmentioning

confidence: 99%

Experimental Investigation on Thermal Conductivity and Thermal Diffusivity of Water-Agar Gel from Room Temperature to –60℃

Campagnoli¹,

Giaretto²

2020

IJHT

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“…For this reason, radiofrequency irrigated catheters, both closed and open loop, have been designed to reduce the electrode‐endothelium interface temperature. Since the 1980s, 14 however, it has been hypothesized that another technologic innovation, such as radiofrequency alternating current, may hold the potential to reduce temperature peaks. Based on this hypothesis, the duty‐cycled radiofrequency generator associated with the PVAC catheter, allowing delivery of simultaneously unipolar and bipolar current with an erogated/not erogated ratio of 10–90% over time, a temperature target of 60 °C and a low‐power output was introduced in clinical practice.…”

Section: Editorial Commentmentioning

confidence: 99%

Unresolved Issues in Transcatheter Atrial Fibrillation Ablation: Silent Cerebrovascular Ischemias

Anselmino

Gaïta

2012

Cardiovasc electrophysiol

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Editorial CommentTranscatheter ablation is an effective approach for treating atrial fibrillation (AF) refractory to antiarrhythmic drugs. The main objective of AF ablation is the maintenance of sinus rhythm with a consequent reduction of AF-related symptoms and thromboembolic events.Within the complications worldwide described following transcathter AF ablation procedures, however, ischemic embolic accidents are the most frequent. In fact, symptomatic thromboembolic events have been reported ranging from 0.5% to 1%. 1 In addition, the use of postablation cerebral magnetic resonance imaging (MRI) 2,3 has proven that an AF ablation procedure may also cause silent cerebral ischemias (SCI) in up to 40-50% of the cases. 4,5 Given the evidence that SCI relate to an increased incidence of strokes, impaired cognitive function, and dementia, they cannot be considered riskless. 6 Physicians performing AF ablation, aiming at controlling symptoms and reducing thromboembolic events should therefore not, in first line, cause them. Several factors that may also coexist during an AF ablation procedure are known to cause SCI (Table 1). The major mechanisms involved include conventional clotting, thermal thrombus formation (charring), and air/gas embolisms.Introduction of any foreign body into the blood pool stimulates clot formation. This mechanism should however be effectively prevented by heparin bolus administration aiming at high activating clotting time (ACT > 300 seconds) and continued oral anticoagulation. Despite these presumptions, to date, contradictory results have been reported. In a study by our group, within 232 consecutive patients with paroxysmal or persistent AF undergoing radiofrequency transcatheter ablation, 33 (14%) reported new SCI at the postprocedural cerebral MRI. Within these, the incidence of SCI was 9% in patients heparinized to an ACT > 250 seconds while nearly double (17%) in those maintaining lower values. 3 In addition to ACT, intraprocedural electric or pharmacological cardioversion to sinus rhythm correlated with an increased incidence of SCI (P = 0.009). Furthermore, preliminary results of an ongoing multicenter study 7 performed, to date, on 51 patients undergoing transcatheter AF ablation under therapeutic oral anticoagulation in addition to a 10,000 U intravenous heparin bolus before transseptal punc-

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Mirror image technique for the thermal analysis in cryoablation: Experimental setup and validation

Giaretto

Passerone

2017

Cryobiology

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History of transcatheter atrial fibrillation ablation

Cited by 14 publications

References 66 publications

Experimental Investigation on Thermal Conductivity and Thermal Diffusivity of Water-Agar Gel from Room Temperature to –60℃

Experimental Investigation on Thermal Conductivity and Thermal Diffusivity of Water-Agar Gel from Room Temperature to –60℃

Unresolved Issues in Transcatheter Atrial Fibrillation Ablation: Silent Cerebrovascular Ischemias

Mirror image technique for the thermal analysis in cryoablation: Experimental setup and validation

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