One-Stage Versus Sequential Hybrid Radiofrequency Ablation: An In Vitro Evaluation

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> To compare lesion size and depth between a 1-step, a sequential, and a delayed radio-frequency ablation in a hybrid setup. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Left atrium tissues obtained from fresh porcine hearts were mounted into the ABLABOX simulator. Based on the time differences between the index epicardial (epi) and consequent endocardial (endo) ablation, 3 study groups were compared: a 1-stage (SEQ- 0) group (0-minute delay), an SEQ 1 group (60-minute delay), and an SEQ 2 group (240-minute delay). During the experiment, a constant epicardial (300 gr) and endocardial (30 gr) force were applied. Per group, 20 samples were studied, and the resulting lesion size and depth were quantified with morphometric evaluation. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Overall, no transmural lesion was obtained. Lesions in SEQ 0 had better maximum and minimum diameters ( P &lt; 0.001), a larger total area ( P &lt; 0.001), and volume ( P &lt; 0.001) than SEQ 1 and SEQ 2. There was no statistical difference in morphometric parameters (all, P &gt; 0.05) between the delayed procedures (SEQ 1 and SEQ 2). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> In our in vitro model, different time sequences of combined epi–endo ablation did not result in transmural lesions. However, simultaneous epi–endo ablation produced broader and deeper lesions. Our findings need to be confirmed by further research. </jats:p></jats:sec>

Hybrid atrial fibrillation ablation: long-term outcomes from a single-centre 10-year experience

“… 23 , 24 Indeed, in a pre-clinical model from our group, simultaneous epi–endo ablation produced broader and deeper lesions. 25 Two-stages hybrid AF ablation might be associated with shorter procedural time and the possibility to assess lesions after oedema resolution.…”

New Biparietal Bipolar Catheter Prototype for Hybrid Atrial Fibrillation Ablation

“…29 Nonetheless, the time-frame between the endocardial and the epicardial steps can vary from a few hours up to 6 months, [30][31][32][33][34][35][36] and some groups perform either onestage or staged procedures. [37][38][39] In our previous experience, 40 we failed to find any difference in lesion depth between single-stage or endocardial procedures performed after a 60-minute delay or after a 240-minute delay. Notably, overall, no transmural lesion was obtained.…”

Bipolar biparietal bidirectional application of radiofrequency in experimental in vitro/in vivo environment

“…Nonetheless, the time-frame between the endocardial and the epicardial steps can vary from a few hours up to 6 months [30][31][32][33][34][35][36] , and some groups perform either one-stage or staged procedures [37][38][39] . In our previous expe-rience 40 , we failed to find any difference in lesion depth between 1-stage or endocardial procedures performed after a 60-minute delay or after a 240-minute delay. Notably, overall, no transmural lesion was obtained.…”

“…However, to date, the superiority of the hybrid procedure over catheter ablation is still reason for debate, and available data come from small case series with variable lesion sets and devices used 43 . Even more rarely published studies have demonstrated the superiority of the hybrid procedure with surgical ablation 40,44 . Nonetheless, encouraging results in terms of being arrhythmia-free and having a reduction of reintervention rates make this technique very promising 40,45 .…”

“…Even more rarely published studies have demonstrated the superiority of the hybrid procedure with surgical ablation 40,44 . Nonetheless, encouraging results in terms of being arrhythmia-free and having a reduction of reintervention rates make this technique very promising 40,45 .…”