Tags

Type your tag names separated by a space and hit enter

Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy.
Circulation. 2004 May 18; 109(19):2363-9.Circ

Abstract

BACKGROUND

Transthoracic epicardial catheter ablation is an emerging catheter ablation strategy being used clinically at increasing frequency. However, the efficacy of standard RF ablation on the epicardial surface of the heart is hindered by (1) the lack of convective cooling of the ablation electrode and (2) the varying presence of epicardial adipose tissue interposed between the ablation electrode and the target site. This experimental animal study examines the biophysical characteristics of radiofrequency (RF) ablation lesions generated by either standard or cooled-tip ablation of the ventricular epicardium.

METHODS AND RESULTS

Nonsurgical subxyphoid pericardial access was achieved in 10 normal goats and 7 pigs with healed myocardial infarctions. A 4-mm cooled-tip RF ablation catheter (continuous 0.9% saline circulation at 0.6 mL/s; goal temperature, 40 degrees C; 60 seconds) was used to deliver epicardial ventricular lesions: 47 in normal tissue and 22 in infarcted tissue. Standard RF ablation lesions (n=33) using a 4-mm top catheter (goal temperature, 70 degrees C; 60 seconds) were also placed on normal epicardial tissue. Lesions created with standard and cooled-tip RF ablation were 3.7+/-1.3 mm (25+/-16.8 W) and 6.7+/-1.7 mm (44.8+/-6.8 W) in depth, respectively. On scar tissue, lesions made with the cooled-tip catheter measured 14.6+/-2.7 mm in length, 11.8+/-2.9 mm in width, and 5.6+/-1.2 mm in depth (35.6+/-7.1 W). In areas covered by epicardial fat (3.1+/-1.2 mm thick), standard RF energy did not generate any appreciable lesions, but cooled-tip RF lesions were 4.1+/-2 mm in depth (45+/-4.4 W).

CONCLUSIONS

Cooled-tip RF ablation can generate epicardial lesions more effectively than standard RF ablation and appears to be of particular benefit in ablating areas with overlying epicardial fat.

Authors+Show Affiliations

d'Avila A
Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
Houghtaling C
No affiliation info available
Gutierrez P
No affiliation info available
Vragovic O
No affiliation info available
Ruskin JN
No affiliation info available
Josephson ME
No affiliation info available
Reddy VY
No affiliation info available

MeSH

Adipose TissueAnimalsCatheter AblationChronic DiseaseCicatrixCold TemperatureCoronary VesselsElectric ConductivityEquipment DesignGoatsHeart VentriclesMyocardial InfarctionPericardiumSwineTachycardia, Ventricular

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15096448

Citation

d'Avila, André, et al. "Catheter Ablation of Ventricular Epicardial Tissue: a Comparison of Standard and Cooled-tip Radiofrequency Energy." Circulation, vol. 109, no. 19, 2004, pp. 2363-9.
d'Avila A, Houghtaling C, Gutierrez P, et al. Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy. Circulation. 2004;109(19):2363-9.
d'Avila, A., Houghtaling, C., Gutierrez, P., Vragovic, O., Ruskin, J. N., Josephson, M. E., & Reddy, V. Y. (2004). Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy. Circulation, 109(19), 2363-9.
d'Avila A, et al. Catheter Ablation of Ventricular Epicardial Tissue: a Comparison of Standard and Cooled-tip Radiofrequency Energy. Circulation. 2004 May 18;109(19):2363-9. PubMed PMID: 15096448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy. AU - d'Avila,André, AU - Houghtaling,Christopher, AU - Gutierrez,Paulo, AU - Vragovic,Olivera, AU - Ruskin,Jeremy N, AU - Josephson,Mark E, AU - Reddy,Vivek Y, Y1 - 2004/04/19/ PY - 2004/4/21/pubmed PY - 2004/10/9/medline PY - 2004/4/21/entrez SP - 2363 EP - 9 JF - Circulation JO - Circulation VL - 109 IS - 19 N2 - BACKGROUND: Transthoracic epicardial catheter ablation is an emerging catheter ablation strategy being used clinically at increasing frequency. However, the efficacy of standard RF ablation on the epicardial surface of the heart is hindered by (1) the lack of convective cooling of the ablation electrode and (2) the varying presence of epicardial adipose tissue interposed between the ablation electrode and the target site. This experimental animal study examines the biophysical characteristics of radiofrequency (RF) ablation lesions generated by either standard or cooled-tip ablation of the ventricular epicardium. METHODS AND RESULTS: Nonsurgical subxyphoid pericardial access was achieved in 10 normal goats and 7 pigs with healed myocardial infarctions. A 4-mm cooled-tip RF ablation catheter (continuous 0.9% saline circulation at 0.6 mL/s; goal temperature, 40 degrees C; 60 seconds) was used to deliver epicardial ventricular lesions: 47 in normal tissue and 22 in infarcted tissue. Standard RF ablation lesions (n=33) using a 4-mm top catheter (goal temperature, 70 degrees C; 60 seconds) were also placed on normal epicardial tissue. Lesions created with standard and cooled-tip RF ablation were 3.7+/-1.3 mm (25+/-16.8 W) and 6.7+/-1.7 mm (44.8+/-6.8 W) in depth, respectively. On scar tissue, lesions made with the cooled-tip catheter measured 14.6+/-2.7 mm in length, 11.8+/-2.9 mm in width, and 5.6+/-1.2 mm in depth (35.6+/-7.1 W). In areas covered by epicardial fat (3.1+/-1.2 mm thick), standard RF energy did not generate any appreciable lesions, but cooled-tip RF lesions were 4.1+/-2 mm in depth (45+/-4.4 W). CONCLUSIONS: Cooled-tip RF ablation can generate epicardial lesions more effectively than standard RF ablation and appears to be of particular benefit in ablating areas with overlying epicardial fat. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15096448/Catheter_ablation_of_ventricular_epicardial_tissue:_a_comparison_of_standard_and_cooled_tip_radiofrequency_energy_ DB - PRIME DP - Unbound Medicine ER -