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In vivo evaluation of virtual electrode mapping and ablation utilizing a direct endocardial visualization ablation catheter.
J Cardiovasc Electrophysiol. 2012 Jan; 23(1):88-95.JC

Abstract

BACKGROUND

Radiofrequency (RF) ablation utilizing direct endocardial visualization (DEV) requires a "virtual electrode" to deliver RF energy while preserving visualization. This study aimed to: (1) examine the virtual electrode RF ablation efficacy; (2) determine the optimal power and duration settings; and (3) evaluate the utility of virtual electrode unipolar electrograms.

METHODS AND RESULTS

The DEV catheter lesions were compared to lesions formed using a 3.5 mm open irrigated tip catheter within the right atria of 12 sheep. Generator power settings for DEV were titrated from 12W, 14W and 16W for 20, 30 and 40 seconds duration with 25 mL/min saline irrigation. Standard irrigated tip catheter settings of 30W, 50°C for 30 seconds and 30 mL/min were used. The DEV lesions were significantly greater in surface area and both major and minor axes compared to irrigated tip lesions (surface area 19.43 ± 9.09 vs 10.88 ± 4.72 mm, P<0.01) with no difference in transmurality (93/94 vs 46/47) or depth (1.86 ± 0.75 vs 1.85 ± 0.57 mm). Absolute electrogram amplitude reduction was greater for DEV lesions (1.89 ± 1.31 vs 1.49 ± 0.78 mV, P = 0.04), but no difference in percentage reduction. Pre-ablation pacing thresholds were not different between DEV (0.79 ± 0.36 mA) and irrigated tip (0.73 ± 0.25 mA) lesions. There were no complications noted during ablation with either catheter.

CONCLUSIONS

Virtual electrode ablation consistently created wider lesions at lower power compared to irrigated tip ablation. Virtual electrode electrograms showed a comparable pacing and sensing efficacy in detecting local myocardial electrophysiological changes.

Authors+Show Affiliations

Cardiology Department, Westmead Hospital, Sydney, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21914025

Citation

Chik, William W B., et al. "In Vivo Evaluation of Virtual Electrode Mapping and Ablation Utilizing a Direct Endocardial Visualization Ablation Catheter." Journal of Cardiovascular Electrophysiology, vol. 23, no. 1, 2012, pp. 88-95.
Chik WW, Barry MA, Malchano Z, et al. In vivo evaluation of virtual electrode mapping and ablation utilizing a direct endocardial visualization ablation catheter. J Cardiovasc Electrophysiol. 2012;23(1):88-95.
Chik, W. W., Barry, M. A., Malchano, Z., Wylie, B., Pouliopoulos, J., Huang, K., Lu, J., Thavapalachandran, S., Robinson, D., Saadat, V., Thomas, S. P., Ross, D. L., Kovoor, P., & Thiagalingam, A. (2012). In vivo evaluation of virtual electrode mapping and ablation utilizing a direct endocardial visualization ablation catheter. Journal of Cardiovascular Electrophysiology, 23(1), 88-95. https://doi.org/10.1111/j.1540-8167.2011.02169.x
Chik WW, et al. In Vivo Evaluation of Virtual Electrode Mapping and Ablation Utilizing a Direct Endocardial Visualization Ablation Catheter. J Cardiovasc Electrophysiol. 2012;23(1):88-95. PubMed PMID: 21914025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vivo evaluation of virtual electrode mapping and ablation utilizing a direct endocardial visualization ablation catheter. AU - Chik,William W B, AU - Barry,M A, AU - Malchano,Zach, AU - Wylie,Bryan, AU - Pouliopoulos,Jim, AU - Huang,Kaimin, AU - Lu,Juntang, AU - Thavapalachandran,Sujitha, AU - Robinson,David, AU - Saadat,Vahid, AU - Thomas,Stuart P, AU - Ross,David L, AU - Kovoor,Pramesh, AU - Thiagalingam,Aravinda, Y1 - 2011/09/13/ PY - 2011/9/15/entrez PY - 2011/9/15/pubmed PY - 2012/5/16/medline SP - 88 EP - 95 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 23 IS - 1 N2 - BACKGROUND: Radiofrequency (RF) ablation utilizing direct endocardial visualization (DEV) requires a "virtual electrode" to deliver RF energy while preserving visualization. This study aimed to: (1) examine the virtual electrode RF ablation efficacy; (2) determine the optimal power and duration settings; and (3) evaluate the utility of virtual electrode unipolar electrograms. METHODS AND RESULTS: The DEV catheter lesions were compared to lesions formed using a 3.5 mm open irrigated tip catheter within the right atria of 12 sheep. Generator power settings for DEV were titrated from 12W, 14W and 16W for 20, 30 and 40 seconds duration with 25 mL/min saline irrigation. Standard irrigated tip catheter settings of 30W, 50°C for 30 seconds and 30 mL/min were used. The DEV lesions were significantly greater in surface area and both major and minor axes compared to irrigated tip lesions (surface area 19.43 ± 9.09 vs 10.88 ± 4.72 mm, P<0.01) with no difference in transmurality (93/94 vs 46/47) or depth (1.86 ± 0.75 vs 1.85 ± 0.57 mm). Absolute electrogram amplitude reduction was greater for DEV lesions (1.89 ± 1.31 vs 1.49 ± 0.78 mV, P = 0.04), but no difference in percentage reduction. Pre-ablation pacing thresholds were not different between DEV (0.79 ± 0.36 mA) and irrigated tip (0.73 ± 0.25 mA) lesions. There were no complications noted during ablation with either catheter. CONCLUSIONS: Virtual electrode ablation consistently created wider lesions at lower power compared to irrigated tip ablation. Virtual electrode electrograms showed a comparable pacing and sensing efficacy in detecting local myocardial electrophysiological changes. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/21914025/In_vivo_evaluation_of_virtual_electrode_mapping_and_ablation_utilizing_a_direct_endocardial_visualization_ablation_catheter_ L2 - https://doi.org/10.1111/j.1540-8167.2011.02169.x DB - PRIME DP - Unbound Medicine ER -