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Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size.
J Cardiovasc Electrophysiol. 2018 08; 29(8):1143-1149.JC

Abstract

INTRODUCTION

Reversible edema is a part of any radiofrequency ablation but its relationship with contact force is unknown. The goal of this study was to characterize through histology and MRI, acute and chronic ablation lesions and reversible edema with contact force.

METHODS AND RESULTS

In a canine model (n = 14), chronic ventricular lesions were created with a 3.5-mm tip ThermoCool SmartTouch (Biosense Webster) catheter at 25 W or 40 W for 30 seconds. Repeat ablation was performed after 3 months to create a second set of lesions (acute). Each ablation procedure was followed by in vivo T2-weighted MRI for edema and late-gadolinium enhancement (LGE) MRI for lesion characterization. For chronic lesions, the mean scar volumes at 25 W and 40 W were 77.8 ± 34.5 mm3 (n = 24) and 139.1 ± 69.7 mm3 (n = 12), respectively. The volume of chronic lesions increased (25 W: P < 0.001, 40 W: P < 0.001) with greater contact force. For acute lesions, the mean volumes of the lesion were 286.0 ± 129.8 mm3 (n = 19) and 422.1 ± 113.1 mm3 (n = 16) for 25 W and 40 W, respectively (P < 0.001 compared to chronic scar). On T2-weighted MRI, the acute edema volume was on average 5.6-8.7 times higher than the acute lesion volume and increased with contact force (25 W: P = 0.001, 40 W: P = 0.011).

CONCLUSION

With increasing contact force, there is a marginal increase in lesion size but accompanied with a significantly larger edema. The reversible edema that is much larger than the chronic lesion volume may explain some of the chronic procedure failures.

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Authors+Show Affiliations

Thomas S
Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA. Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.
Silvernagel J
Department of Bioengineering, University of Utah, Salt Lake City, UT, USA. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
Angel N
Department of Bioengineering, University of Utah, Salt Lake City, UT, USA. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
Kholmovski E
UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA. CARMA Center, University of Utah, Salt Lake City, UT, USA.
Ghafoori E
Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA. Department of Bioengineering, University of Utah, Salt Lake City, UT, USA. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA. Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
Hu N
Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA.
Ashton J
Biosense Webster, Irwindale, CA, USA.
Dosdall DJ
Department of Bioengineering, University of Utah, Salt Lake City, UT, USA. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA. Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA. Division of Cardiothoracic Surgery, University of Utah,, Salt Lake City, UT, USA.
MacLeod R
Department of Bioengineering, University of Utah, Salt Lake City, UT, USA. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA. Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
Ranjan R
Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA. Department of Bioengineering, University of Utah, Salt Lake City, UT, USA. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA. Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.

MeSH

AnimalsContrast MediaDogsEdema, CardiacRadiofrequency Ablation

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29777548

Citation

Thomas, Samuel, et al. "Higher Contact Force During Radiofrequency Ablation Leads to a Much Larger Increase in Edema as Compared to Chronic Lesion Size." Journal of Cardiovascular Electrophysiology, vol. 29, no. 8, 2018, pp. 1143-1149.
Thomas S, Silvernagel J, Angel N, et al. Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size. J Cardiovasc Electrophysiol. 2018;29(8):1143-1149.
Thomas, S., Silvernagel, J., Angel, N., Kholmovski, E., Ghafoori, E., Hu, N., Ashton, J., Dosdall, D. J., MacLeod, R., & Ranjan, R. (2018). Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size. Journal of Cardiovascular Electrophysiology, 29(8), 1143-1149. https://doi.org/10.1111/jce.13636
Thomas S, et al. Higher Contact Force During Radiofrequency Ablation Leads to a Much Larger Increase in Edema as Compared to Chronic Lesion Size. J Cardiovasc Electrophysiol. 2018;29(8):1143-1149. PubMed PMID: 29777548.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size. AU - Thomas,Samuel, AU - Silvernagel,Josh, AU - Angel,Nathan, AU - Kholmovski,Eugene, AU - Ghafoori,Elyar, AU - Hu,Nan, AU - Ashton,John, AU - Dosdall,Derek J, AU - MacLeod,Rob, AU - Ranjan,Ravi, Y1 - 2018/06/06/ PY - 2018/03/29/received PY - 2018/04/25/revised PY - 2018/04/27/accepted PY - 2018/5/20/pubmed PY - 2019/11/8/medline PY - 2018/5/20/entrez KW - MRI KW - RF ablation KW - acute and chronic lesions KW - contact force KW - edema KW - lesion visualization SP - 1143 EP - 1149 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 29 IS - 8 N2 - INTRODUCTION: Reversible edema is a part of any radiofrequency ablation but its relationship with contact force is unknown. The goal of this study was to characterize through histology and MRI, acute and chronic ablation lesions and reversible edema with contact force. METHODS AND RESULTS: In a canine model (n = 14), chronic ventricular lesions were created with a 3.5-mm tip ThermoCool SmartTouch (Biosense Webster) catheter at 25 W or 40 W for 30 seconds. Repeat ablation was performed after 3 months to create a second set of lesions (acute). Each ablation procedure was followed by in vivo T2-weighted MRI for edema and late-gadolinium enhancement (LGE) MRI for lesion characterization. For chronic lesions, the mean scar volumes at 25 W and 40 W were 77.8 ± 34.5 mm3 (n = 24) and 139.1 ± 69.7 mm3 (n = 12), respectively. The volume of chronic lesions increased (25 W: P < 0.001, 40 W: P < 0.001) with greater contact force. For acute lesions, the mean volumes of the lesion were 286.0 ± 129.8 mm3 (n = 19) and 422.1 ± 113.1 mm3 (n = 16) for 25 W and 40 W, respectively (P < 0.001 compared to chronic scar). On T2-weighted MRI, the acute edema volume was on average 5.6-8.7 times higher than the acute lesion volume and increased with contact force (25 W: P = 0.001, 40 W: P = 0.011). CONCLUSION: With increasing contact force, there is a marginal increase in lesion size but accompanied with a significantly larger edema. The reversible edema that is much larger than the chronic lesion volume may explain some of the chronic procedure failures. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/29777548/Higher_contact_force_during_radiofrequency_ablation_leads_to_a_much_larger_increase_in_edema_as_compared_to_chronic_lesion_size_ DB - PRIME DP - Unbound Medicine ER -