Temperature-Controlled Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Atrial Fibrillation

Iwasawa, Jin; Koruth, Jacob S.; Petrů, Jan; Dujka, Libor; Královec, Štěpán; Mzourkova, Katerina; Dukkipati, Srinivas R.; Neužil, Petr; Reddy, Vivek Y.

doi:10.1016/j.jacc.2017.06.008

Cited by 69 publications

(70 citation statements)

References 16 publications

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“…For complex and larger anatomical structures which require multiple discrete or drag lesions, this demonstration of a transmural lesion extends longitudinally along the compound lesion line. A goal of correlating effectiveness at these locations, particularly PV antra is to show a contiguous, transmural lesion, as a break in transmurality compromises the ability to electrically isolate the anatomical structure (Koruth et al 2015; Iwasawa et al 2017).…”

Section: Effectivenessmentioning

confidence: 99%

Pathology Approaches to Determine Safety and Efficacy of Cardiac Ablation Catheters

Stoffregen

Rousselle²,

Rippy³

2019

Toxicol Pathol

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Cardiac electrophysiology utilizes nonimplantable, catheter-based devices for diagnosis and treatment of arrhythmias as well as electroanatomical mapping of cardiac chambers. Gross pathology and histopathological assessments in preclinical studies play critical roles in determining the safety and efficacy of cardiac ablation systems used to treat tachyarrhythmias. The pathologist must assess ablation sites, adjacent structures and organs, and downstream organs to characterize the effects of the ablation treatment and determine whether adverse local reactions, collateral injury, or downstream thromboembolism are present. Histopathological assessment serves as an adjunct to electroanatomical data in determining efficacy in preclinical studies. Histopathology is the standard in definitively demonstrating transmurality of ablation lesions, which is necessary for complete conduction block, as well as showing the linear or circumferential distribution of a contiguous, transmural ablation lesion necessary for electroanatomical isolation of entire target structures such as pulmonary veins and the cavotricuspid isthmus, which are involved in propagating certain arrhythmias. This article will detail gross and histological methods for the pathology assessment of preclinical studies evaluating the safety and/or efficacy of cardiac ablation catheter systems as well as discuss correlation of pathology data with other supporting evidence for safety and efficacy such as acute, electroanatomical data.

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Section: Effectivenessmentioning

confidence: 99%

Pathology Approaches to Determine Safety and Efficacy of Cardiac Ablation Catheters

Stoffregen

Rousselle²,

Rippy³

2019

Toxicol Pathol

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“…An improved appreciation of RF biophysics specific to thin atrial tissue has also led to the increased use of high power‐short duration ablation, in an attempt to take advantage of the wide and somewhat shallow ablation footprint seen with this mode of RF delivery 3,5 . On the basis of this lesion morphology, the newer 3.5 mm tip technologies such as the diamond‐tip temperature‐controlled ablation system (EPIX Therapeutics), as well as surface‐thermocouple controlled delivery of 90 W for 4 seconds (QDot, Biosense Webster) are being evaluated for paroxysmal AF ablation 6,9,10 . Although promising, one aspect common to all of these technologies is the 3.5 mm tip platform.…”

Section: Discussionmentioning

confidence: 99%

Feasibility, safety, and durability of porcine atrial ablation using a lattice‐tip temperature‐controlled radiofrequency ablation catheter

Koruth

Kuroki

Iwasawa

et al. 2020

Cardiovasc electrophysiol

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Introduction: Pulmonary vein isolation (PVI) using standard radiofrequency (RF) catheters is limited by incomplete contiguity and prolonged procedural times. A novel, 9-mm lattice-tip irrigated RF catheter can create wide lesions rapidly in swine atria.Methods: In five swine, temperature limited (75°C) irrigated RF for 5 seconds/ablation was selected, to isolate seven pulmonary veins (PVs; five right superior and two inferior commons) and create five right atrial lines. After 4 weeks, repeat mapping and additional ablation to create atrial isthmus lesions were performed.The chronic lesions were submitted for histology. This was compared with right superior PVI data using standard 3.5-mm irrigated tip ablation in six swine.Results: All targeted PVs (seven of seven, 100%) were acutely isolated. Durable isolation was observed in all six of six PVs treated with 5-second applications, but not in one PV inadvertently treated with 4-second applications. For the durably isolated PVs, the mean lesion count/PV and total RF time/PV was 16.3 ± 5.2 applications and 81.3 ± 25.9 seconds for the right superior and 14.5 ± 0.7 applications and 71.1 ± 5.5 seconds for the inferior common PV. Right atrial linear ablation was performed with a lesion count of 12 ± 2.3 applications and RF times of 59.5 ± 12.5 seconds. Cavotricuspid and mitral isthmus linear ablations were transmural along their entire length. All 53 of 53 (100%) sections were transmural on histology.Conclusion: Rapid and durable PVI and linear atrial ablation is feasible with this novel 9-mm lattice-tip catheter. K E Y W O R D S catheter ablation-atrial fibrillation, durable, isolation, isthmus, pulmonary vein, swine, temperature Abbreviations: CTI, cavotricuspid isthmus; ICPV, inferior common pulmonary vein; MI, mitral isthmus; PV, pulmonary vein; RA, right atrial; RF, radiofrequency; RSPV, right superior pulmonary vein. Koruth: Atrial ablation in Swine using a lattice-tip catheter. 1324 | KORUTH ET AL.

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“…Iwasawa and colleagues reported that the use of this catheter is feasible in a single-center series. 30 The authors suggest that using temperature control allows for an appropriate modulation of power so as to achieve transmurality without the risk of steam pops or char formation. Temperature feedback, of course, is used in traditional nonirrigated ablation and has long been understood to have the greatest correlation with lesion depth in standard radiofrequency (RF) ablation.…”

Section: Atrial Fibrillation Ablationmentioning

confidence: 99%

Review on Atrial Fibrillation

Doshi

2017

J Innov Cardiac Rhythm Manage

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Temperature-Controlled Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Atrial Fibrillation

Abstract: This first-in-human series demonstrated that temperature-controlled irrigated ablation produced rapid, efficient, and durable PV isolation. (ACT DiamondTemp Temperature-Controlled and Contact Sensing RF Ablation Clinical Trial for Atrial Fibrillation [TRAC-AF]; NCT02821351).

Cited by 69 publications

References 16 publications

Pathology Approaches to Determine Safety and Efficacy of Cardiac Ablation Catheters

Pathology Approaches to Determine Safety and Efficacy of Cardiac Ablation Catheters

Feasibility, safety, and durability of porcine atrial ablation using a lattice‐tip temperature‐controlled radiofrequency ablation catheter

Review on Atrial Fibrillation

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