The Relationship between Surface Temperature, Tissue Temperature, Microbubble Formation, and Steam Pops

Thompson, Nathaniel; Lustgarten, Daniel L.; Mason, B.; Mueller, Enkhtuyaa; Calame, James; Bell, Stephen P.; Spector, Peter

doi:10.1111/j.1540-8159.2009.02397.x

Cited by 13 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, even when not intending to deploy higher energy, it is often the case that sufficient energy is deployed to result in a steam pop. Steam pops occur when tissue temperature exceeds 100 °C, and in fact, experimental measurements have found tissue temperatures of 102 ± 17 °C reached during steam pop formation [22]. Steam pops are common when cooled electrode temperature exceeds 40 °C and are not predictable from power or impedance drop, but small impedance rises and sudden drops in measured electrode temperature indicate possible steam formation [23].…”

Section: Discussionmentioning

confidence: 99%

Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions

et al. 2020

View full text Add to dashboard Cite

Background Esophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation. Existing methods to prevent esophageal injury have various limitations in deployment and uncertainty in efficacy. A new esophageal heat transfer device currently available for whole-body cooling or warming may offer an additional option to prevent esophageal injury. We sought to develop a mathematical model of this process to guide further studies and clinical investigations and compare results to real-world clinical data. Results The model predicts that the esophageal cooling device, even with body-temperature water flow (37 °C) provides a reduction in esophageal thermal injury compared to the case of the non-protected esophagus, with a non-linear direct relationship between lesion depth and the cooling water temperature. Ablation power and cooling water temperature have a significant influence on the peak temperature and the esophageal lesion depth, but even at high RF power up to 50 W, over durations up to 20 s, the cooling device can reduce thermal impact on the esophagus. The model concurs with recent clinical data showing an 83% reduction in transmural thermal injury when using typical operating parameters. Conclusions An esophageal cooling device appears effective for esophageal protection during atrial fibrillation, with model output supporting clinical data. Analysis of the impact of ablation power and heart wall dimensions suggests that cooling water temperature can be adjusted for specific ablation parameters to assure the desired myocardial tissue ablation while keeping the esophagus protected.

show abstract

Section: Discussionmentioning

confidence: 99%

Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In terms of clinical application, it is especially important that both models should accurately predict the lesion surface width and the maximum blood temperature achieved around the electrode tip, since it is known that these parameters are related to thrombus formation [ 1 , 13 , 14 ]. It is also important that they be able to predict the maximum temperature in the tissue, since values of around 100 °C are associated with the formation of steam pops [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Should fluid dynamics be included in computer models of RF cardiac ablation by irrigated-tip electrodes?

2018

View full text Add to dashboard Cite

BackgroundAlthough accurate modeling of the thermal performance of irrigated-tip electrodes in radiofrequency cardiac ablation requires the solution of a triple coupled problem involving simultaneous electrical conduction, heat transfer, and fluid dynamics, in certain cases it is difficult to combine the software with the expertise necessary to solve these coupled problems, so that reduced models have to be considered. We here focus on a reduced model which avoids the fluid dynamics problem by setting a constant temperature at the electrode tip. Our aim was to compare the reduced and full models in terms of predicting lesion dimensions and the temperatures reached in tissue and blood.ResultsThe results showed that the reduced model overestimates the lesion surface width by up to 5 mm (i.e. 70%) for any electrode insertion depth and blood flow rate. Likewise, it drastically overestimates the maximum blood temperature by more than 15 °C in all cases. However, the reduced model is able to predict lesion depth reasonably well (within 0.1 mm of the full model), and also the maximum tissue temperature (difference always less than 3 °C). These results were valid throughout the entire ablation time (60 s) and regardless of blood flow rate and electrode insertion depth (ranging from 0.5 to 1.5 mm).ConclusionsThe findings suggest that the reduced model is not able to predict either the lesion surface width or the maximum temperature reached in the blood, and so would not be suitable for the study of issues related to blood temperature, such as the incidence of thrombus formation during ablation. However, it could be used to study issues related to maximum tissue temperature, such as the steam pop phenomenon.

show abstract

“…Although measuring contact force has been suggested as a way of limiting force delivery and subsequent steam pops, in the recent TOCCATA study there were audible pops in 16% of cases; however, the force at which the pops occurred was not stated. In an earlier animal study, there was an increased incidence of steam pops at higher contact force; 13 however, steam pops could occur at low force, and contact force was not predictive of steam pops. In contrast, US is able to accurately demonstrate steam formation prior to a potential pop, and if power delivery is terminated, intramyocardial steam can dissipate within the tissue without venting to the surface.…”

Section: Discussionmentioning

confidence: 74%

“…11 During the steam pop, gas is vented from the myocardium to the tissue surface, which tends to displace the catheter tip, leading to a rise in impedance. 7 Numerous studies in addition to the data presented in this study have demonstrated that changes in impedance during ablation and at the time of the steam pop are poorly correlated with the ability to either predict or detect steam pops, 7,9,[11][12][13] which ultimately can lead to cardiac tamponade, 2 the leading cause of death due to AF ablation. 5 Intracardiac echocardiography has been suggested as a possible way to prevent steam pops by observing the formation of microbubbles.…”

Section: Discussionmentioning

confidence: 99%

Visualizing Intramyocardial Steam Formation with a Radiofrequency Ablation Catheter Incorporating Near‐Field Ultrasound

Wright

Harks

Deladi

et al. 2013

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

The Relationship between Surface Temperature, Tissue Temperature, Microbubble Formation, and Steam Pops

Cited by 13 publications

References 25 publications

Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions

Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions

Should fluid dynamics be included in computer models of RF cardiac ablation by irrigated-tip electrodes?

Visualizing Intramyocardial Steam Formation with a Radiofrequency Ablation Catheter Incorporating Near‐Field Ultrasound

Contact Info

Product

Resources

About