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Endocardial versus epicardial ventricular radiofrequency ablation: utility of in vivo contact force assessment.
Circ Arrhythm Electrophysiol. 2013 Feb; 6(1):144-50.CA

Abstract

BACKGROUND

Contact force (CF) is an important determinant of lesion formation for atrial endocardial radiofrequency ablation. There are minimal published data on CF and ventricular lesion formation. We studied the impact of CF on lesion formation using an ovine model both endocardially and epicardially.

METHODS AND RESULTS

Twenty sheep received 160 epicardial and 160 endocardial ventricular radiofrequency applications using either a 3.5-mm irrigated-tip catheter (Thermocool, Biosense-Webster, n=160) or a 3.5 irrigated-tip catheter with CF assessment (Tacticath, Endosense, n=160), via percutaneous access. Power was delivered at 30 watts for 60 seconds, when either catheter/tissue contact was felt to be good or when CF>10 g with Tacticath. After completion of all lesions, acute dimensions were taken at pathology. Identifiable lesion formation from radiofrequency application was improved with the aid of CF information, from 78% to 98% on the endocardium (P<0.001) and from 90% to 100% on the epicardium (P=0.02). The mean total force was greater on the endocardium (39±18 g versus 21±14 g for the epicardium; P<0.001) mainly because of axial force. Despite the force-time integral being greater endocardially, epicardial lesions were larger (231±182 mm(3) versus 209±131 mm(3); P=0.02) probably because of the absence of the heat sink effect of the circulating blood and covered a greater area (41±27 mm(2) versus 29±17 mm(2); P=0.03) because of catheter orientation.

CONCLUSIONS

In the absence of CF feedback, 22% of endocardial radiofrequency applications that are thought to have good contact did not result in lesion formation. Epicardial ablation is associated with larger lesions.

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Authors+Show Affiliations

Sacher F
Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
Wright M
No affiliation info available
Derval N
No affiliation info available
Denis A
No affiliation info available
Ramoul K
No affiliation info available
Roten L
No affiliation info available
Pascale P
No affiliation info available
Bordachar P
No affiliation info available
Ritter P
No affiliation info available
Hocini M
No affiliation info available
Dos Santos P
No affiliation info available
Haissaguerre M
No affiliation info available
Jais P
No affiliation info available

MeSH

AnimalsCardiac CathetersCatheter AblationEndocardiumEquipment DesignHeart VentriclesPericardiumSheepTherapeutic Irrigation

Pub Type(s)

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

Language

eng

PubMed ID

23392586

Citation

Sacher, Frederic, et al. "Endocardial Versus Epicardial Ventricular Radiofrequency Ablation: Utility of in Vivo Contact Force Assessment." Circulation. Arrhythmia and Electrophysiology, vol. 6, no. 1, 2013, pp. 144-50.
Sacher F, Wright M, Derval N, et al. Endocardial versus epicardial ventricular radiofrequency ablation: utility of in vivo contact force assessment. Circ Arrhythm Electrophysiol. 2013;6(1):144-50.
Sacher, F., Wright, M., Derval, N., Denis, A., Ramoul, K., Roten, L., Pascale, P., Bordachar, P., Ritter, P., Hocini, M., Dos Santos, P., Haissaguerre, M., & Jais, P. (2013). Endocardial versus epicardial ventricular radiofrequency ablation: utility of in vivo contact force assessment. Circulation. Arrhythmia and Electrophysiology, 6(1), 144-50. https://doi.org/10.1161/CIRCEP.111.974501
Sacher F, et al. Endocardial Versus Epicardial Ventricular Radiofrequency Ablation: Utility of in Vivo Contact Force Assessment. Circ Arrhythm Electrophysiol. 2013;6(1):144-50. PubMed PMID: 23392586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endocardial versus epicardial ventricular radiofrequency ablation: utility of in vivo contact force assessment. AU - Sacher,Frederic, AU - Wright,Matthew, AU - Derval,Nicolas, AU - Denis,Arnaud, AU - Ramoul,Khaled, AU - Roten,Laurent, AU - Pascale,Patrizzio, AU - Bordachar,Pierre, AU - Ritter,Philippe, AU - Hocini,Meleze, AU - Dos Santos,Pierre, AU - Haissaguerre,Michel, AU - Jais,Pierre, Y1 - 2013/02/07/ PY - 2013/2/9/entrez PY - 2013/2/9/pubmed PY - 2013/4/20/medline SP - 144 EP - 50 JF - Circulation. Arrhythmia and electrophysiology JO - Circ Arrhythm Electrophysiol VL - 6 IS - 1 N2 - BACKGROUND: Contact force (CF) is an important determinant of lesion formation for atrial endocardial radiofrequency ablation. There are minimal published data on CF and ventricular lesion formation. We studied the impact of CF on lesion formation using an ovine model both endocardially and epicardially. METHODS AND RESULTS: Twenty sheep received 160 epicardial and 160 endocardial ventricular radiofrequency applications using either a 3.5-mm irrigated-tip catheter (Thermocool, Biosense-Webster, n=160) or a 3.5 irrigated-tip catheter with CF assessment (Tacticath, Endosense, n=160), via percutaneous access. Power was delivered at 30 watts for 60 seconds, when either catheter/tissue contact was felt to be good or when CF>10 g with Tacticath. After completion of all lesions, acute dimensions were taken at pathology. Identifiable lesion formation from radiofrequency application was improved with the aid of CF information, from 78% to 98% on the endocardium (P<0.001) and from 90% to 100% on the epicardium (P=0.02). The mean total force was greater on the endocardium (39±18 g versus 21±14 g for the epicardium; P<0.001) mainly because of axial force. Despite the force-time integral being greater endocardially, epicardial lesions were larger (231±182 mm(3) versus 209±131 mm(3); P=0.02) probably because of the absence of the heat sink effect of the circulating blood and covered a greater area (41±27 mm(2) versus 29±17 mm(2); P=0.03) because of catheter orientation. CONCLUSIONS: In the absence of CF feedback, 22% of endocardial radiofrequency applications that are thought to have good contact did not result in lesion formation. Epicardial ablation is associated with larger lesions. SN - 1941-3084 UR - https://www.unboundmedicine.com/medline/citation/23392586/Endocardial_versus_epicardial_ventricular_radiofrequency_ablation:_utility_of_in_vivo_contact_force_assessment_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCEP.111.974501?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -