The Effect of Contact Force in Atrial Radiofrequency Ablation

Williams, Steven E.; Harrison, James; Chubb, Henry; Bloch, Lars; Andersen, Niels Peter; Dam, Høgni; Karim, Rashed; Whitaker, John; Gill, Jaswinder; Cooklin, Michael; Rinaldi, Christopher Aldo; Rhode, Kawal; Wright, Matthew; Schaeffter, Tobias; Kim, Won Yong; Jensen, Henrik Kjærulf; Razavi, Reza; O’Neill, Mark

doi:10.1016/j.jacep.2015.06.003

Cited by 31 publications

(16 citation statements)

References 24 publications

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“…In addition, contact force maps during ablation were created by analysis of ablation tags. Gap sizes determined on these ablation contact force maps using a lower contact force threshold of 5g (11) were also compared to eventual chronic macroscopic gap sizes.…”

Section: Ablation Gap Sizementioning

confidence: 99%

“…Before commencing ablation, smooth catheter movement along the proposed line was confirmed. Ablation was performed via the ablation catheter (3.5mm irrigated tip at 17mls/min) at a temperature of 42°C and a power of 30W with sufficient contact force to maintain catheter stability (11). Ablation was performed as a continuous drag with the catheter moved every 30 seconds.…”

Section: Electroanatomic Mapping and Ablationmentioning

confidence: 99%

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Voltage and pace-capture mapping of linear ablation lesions overestimates chronic ablation gap size

et al. 2018

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Section: Ablation Gap Sizementioning

confidence: 99%

Section: Electroanatomic Mapping and Ablationmentioning

confidence: 99%

Voltage and pace-capture mapping of linear ablation lesions overestimates chronic ablation gap size

et al. 2018

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“…Despite best efforts, arrhythmia recurrence following catheter ablation is commonly observed . Prior studies have shown that there can be a significant edema formation during ablation and some of the recurrences has been attributed to the creation of this edema and as a result, reversible block . Deeper and bigger lesions can be made by using higher contact force, but higher contact force is also associated with more complications like steam pops as well as edema .…”

Section: Introductionmentioning

confidence: 99%

Characterization of edema after cryo and radiofrequency ablations based on serial magnetic resonance imaging

Yamashita

Kholmovski

Ghafoori

et al. 2018

Cardiovasc electrophysiol

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Introduction: Radiofrequency (RF) and cryoablation are routinely used to treat arrhythmias, but the extent and time course of edema associated with the two different modalities is unknown. Our goal was to follow the lesion maturation and edema formation after RF and cryoablation using serial magnetic resonance imaging (MRI).Methods and Results: Ventricular ablation was performed in a canine model (n = 11) using a cryo or an irrigated RF catheter. T2-weighted (T2w) edema imaging and late gadolinium enhancement (LGE)-MRI were done immediately (0 day: acute), 1 to 2 weeks (subacute), and 8 to 12 weeks (chronic) after ablation. After the final MRI, excised hearts underwent pathological evaluation. As a result, 45 ventricular lesions (cryo group: 20; RF group: 25) were evaluated. Acute LGE volume was not significantly different but acute edema volume in cryo group was significantly smaller (1225.0 ± 263.5 vs 1855.2 ± 520.5 mm 3 ; P = 0.01). One week after ablation, edema still existed in both group but was similar in size. Two weeks after ablation there was no edema in either of the groups. In the chronic phase, the lesion volume for cryo and RF in LGE-MRI (296.7 ± 156.4 vs 281.6 ± 140.8 mm 3 ; P = 0.73); and pathology (243.3 ± 125.9 vs 214.5 ± 148.6 mm 3 ; P = 0.49), as well as depth, was comparable.Conclusions: When comparing cryo and RF lesions of similar chronic size, acute edema is larger for RF lesions. Edema resolves in both cryo and RF lesions in 1 to 2 weeks. K E Y W O R D S catheter ablation, cryoablation, late gadolinium enhancement, magnetic resonance imaging, radiofrequency 1 | INTRODUCTION Cryo and radiofrequency (RF) ablations are routinely used to treat cardiac arrhythmias. 1 Ablation success depends on creating durable lesions. Despite best efforts, arrhythmia recurrence following catheter ablation is commonly observed. 2,3 Prior studies have shown that there can be a significant edema formation during ablation 4 and some of the recurrences has been attributed to the creation of this edema and as a J Cardiovasc Electrophysiol. 2019;30:255-262. wileyonlinelibrary.com/journal/jce © 2018 Wiley Periodicals, Inc. | 255 O R I G I N A L A R T I C L Eresult, reversible block. 5 Deeper and bigger lesions can be made by using higher contact force, but higher contact force is also associated with more complications like steam pops as well as edema. 6,7 We have also recently reported the large extent of edema that is associated with RF ablation and that it resolves over the span of few weeks. 8 However, the differences between the creation and timeline of edema associated with cryo vs RF are still unknown.Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate myocardial scar after catheter ablation and T2-weighted (T2w) MRI has been used to estimate edema. [9][10][11] Our goal in this study was to study the timeline and differences between edema and lesion maturation between cryo and RF ablation by using serial MRI for acute and chronic ablation lesions of similar size.

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“…In animal models, it has long been established that ventricular and atrial lesions can be visualised immediately following ablation. 47,55 Detailed delineation of the pharmacokinetics of gadolinium within acute RF injury lesions 24 has been performed, and has been correlated with nonenhanced sequences such as T2-weighted, turbo-spin echo techniques. Non-contrast agent-based imaging techniques are particularly attractive as they can be repeated multiple times.…”

Section: Acute Lesion Imaging (<4 Hours)mentioning

confidence: 99%

Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology

Chubb¹,

Williams²,

Whitaker³

et al. 2017

Arrhythm Electrophysiol Rev

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MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.

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The Effect of Contact Force in Atrial Radiofrequency Ablation

Abstract: Although high CF (>20 g) resulted in more acute tissue edema than low CF (<10 g), chronically there was no difference in lesion size, quality, or transmurality. Appropriate CF targets for atrial ablation may be lower than previously thought.

Cited by 31 publications

References 24 publications

Voltage and pace-capture mapping of linear ablation lesions overestimates chronic ablation gap size

Voltage and pace-capture mapping of linear ablation lesions overestimates chronic ablation gap size

Characterization of edema after cryo and radiofrequency ablations based on serial magnetic resonance imaging

Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology

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