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Irrigated Needle Ablation Creates Larger and More Transmural Ventricular Lesions Compared With Standard Unipolar Ablation in an Ovine Model.

Abstract

BACKGROUND

Ventricular tachycardia recurrence can occur after ventricular tachycardia ablation because of incomplete and nontransmural ventricular lesion formation. We sought to compare the lesions made by a novel irrigated needle catheter to conventional radiofrequency lesions.

METHODS AND RESULTS

Thirteen female sheep (4.6±0.7 years, 54±8 kg) were studied. In 7 sheep, 60-s radiofrequency applications were performed using an irrigated needle catheter. In 6 sheep, conventional lesions were made using a 4-mm irrigated catheter. 1.5T in vivo and high-density magnetic resonance imaging (9.4T) were performed on explanted hearts from animals receiving needle radiofrequency. Conventional lesion volume was calculated as (1/6)×π×(A×B(2)+C×D(2)/2). Needle lesion volume was measured as Σ(π×r(2))/2 with a slice thickness of 1 mm. The dimensions of all lesions were also measured on gross pathology. Additional histological analysis of the needle lesions was performed. One hundred twenty endocardial left ventricular ablation lesions (conventional, n=60; needle, n=60) were created. At necropsy, more lesions were found using needle versus conventional radiofrequency (90% versus 75%; P<0.05). Comparing needle versus conventional radiofrequency: lesion volume was larger (1030±362 versus 488±384 mm(3); P<0.001), lesion depth was increased (9.9±2.7 versus 5±2.4 mm; P<0.001), and more transmural lesions were created (62.5% versus 17%; P<0.01). Pericardial contrast injection was observed in 4 apical attempts using needle radiofrequency, however, with no adverse effects. Steam pops occurred in 3 attempts using conventional radiofrequency.

CONCLUSIONS

Irrigated needle ablation is associated with more frequent, larger, deeper, and more often transmural lesions compared with conventional irrigated ablation. This technology might be of value to treat intramural or epicardial ventricular tachycardia substrates resistant to conventional ablation.

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    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    ,

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.).

    From the Department of Cardiology and Radiology, Hôpital Haut-l'évêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France (B.B., H.C., X.P., F.C., S.Y., S.M., N.D., M. Hocini, M. Haïssaguerre, F.S., P.J.); LIRYC Institute, Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., H.C., J.M., J.N., M. Hocini, B.Q., O.B., M. Haïssaguerre, F.S., P.J.); Biosense Webster, Research and Development Department, Palo Alto, CA (D.G.); and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (R.W.). pierre.jais@chu-bordeaux.fr.

    Source

    MeSH

    Animals
    Biopsy
    Cardiac Catheters
    Cardiac Pacing, Artificial
    Catheter Ablation
    Disease Models, Animal
    Electrophysiologic Techniques, Cardiac
    Equipment Design
    Female
    Heart Ventricles
    Magnetic Resonance Imaging
    Needles
    Sheep
    Tachycardia, Ventricular
    Therapeutic Irrigation
    Ventricular Fibrillation

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    26359480