Abstract
Background
Lesion formation during catheter ablation is influenced by the power, contact force (CF), time, and catheter stability. However, the influence of the irrigation effects on lesion formation remains unknown.
Methods
An ex vivo experiment using conductive gel was performed. Using three different catheter designs (TactiFlex ™ SE [TF], IntellaNav MiFi ™ OI [MiFi], QDOT MICRO™ [QDOT]), a cross-sectional analysis of the lesion size and surface lesion type of 10g/40W lesions with a combination of various ablation times was performed in protocol 1. A longitudinal analysis (combination of various powers [30, 40, and 50W] and various ablation times with a 10g setting) was performed to investigate the influence of the auto-regulated irrigation system (QDOT) on lesion formation in protocol 2.
Results
The lesion formation with the QDOT catheter tended to create larger ablation lesions, while that with the TF catheter created smaller lesions than the other catheters. The lesion surface characteristics were divided into two patterns: ring (MiFi catheter and QDOT) and crescent (TF) patterns. The auto-regulated irrigation system did not influence the lesion formation, and the relationship between the lesion formation and RF energy exhibited similar changes regardless of the ablation power setting.
Conclusion
The lesion formation and lesion surface characteristics differed among the different irrigation tip designs. An auto-regulated irrigation system did not affect the lesion creation or surface lesion characteristics. Care should be given to the inter-product differences in the lesion characteristics during RF catheter ablation, partly due to the irrigation flow control and tip design.
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Code availability
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References
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444.
Nogami A, Kurita T, Abe H, et al. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm. 2021;37(4):709–870.
Jilek C, Ullah W. Pulmonary vein reconnections or substrate in the left atrium: what is the reason for atrial fibrillation recurrences? A dialogue on a pressing clinical situation. Europace. 2019;21(Supplement_1):i12–i20.
Ganesan AN, Shipp NJ, Brooks AG, et al. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(2): e004549.
Wittkampf FH, Nakagawa H. RF catheter ablation: lessons on lesions. Pacing Clin Electrophysiol. 2006;29(11):1285–97.
Nakagawa H, Jackman WM. The role of contact force in atrial fibrillation ablation. J Atr Fibrillation. 2014;7(1):1027.
Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of contact force sensing in catheter ablation of cardiac arrhythmias: evolution or history repeating itself? JACC Clin Electrophysiol. 2018;4(6):707–23.
Ullah W, Hunter RJ, Finlay MC, et al. Ablation index and surround flow catheter irrigation: impedance-based appraisal in clinical ablation. JACC Clin Electrophysiol. 2017;3(10):1080–8.
Barkagan M, Leshem E, Rottmann M, Sroubek J, Shapira-Daniels A, Anter E. Expandable lattice electrode ablation catheter: a novel radiofrequency platform allowing high current at low density for rapid, titratable, and durable lesions. Circ Arrhythm Electrophysiol. 2019;12(4): e007090.
Hussein A, Das M, Riva S, et al. Use of ablation index-guided ablation results in high rates of durable pulmonary vein isolation and freedom from arrhythmia in persistent atrial fibrillation patients: the praise study results. Circ Arrhythm Electrophysiol. 2018;11(9): e006576.
Venkatesh Prasad K, Bonso A, Woods CE, et al. Lesion Index-guided workflow for the treatment of paroxysmal atrial fibrillation is safe and effective - final results from the LSI workflow study. Heart Rhythm O2. 2022;3(5):526–35.
Weiss C, Antz M, Eick O, Eshagzaiy K, Meinertz T, Willems S. Radiofrequency catheter ablation using cooled electrodes: impact of irrigation flow rate and catheter contact pressure on lesion dimensions. Pacing Clin Electrophysiol. 2002;25(4 Pt 1):463–9.
Mori H, Kato R, Sumitomo N, et al. Relationship between the ablation index, lesion formation, and incidence of steam pops. J Arrhythm. 2019;35(4):636–44.
Wittkampf FH, Nakagawa H, Foresti S, Aoyama H, Jackman WM. Saline-irrigated radiofrequency ablation electrode with external cooling. J Cardiovasc Electrophysiol. 2005;16(3):323–8.
Haines DE, Watson DD, Verow AF. Electrode radius predicts lesion radius during radiofrequency energy heating. Validation of a proposed thermodynamic model. Circ Res. 1990;67(1):124–9.
Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.
Haïssaguerre M, Shah DC, Jaïs P, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation. 2000;102(20):2463–5.
Gepstein L, Hayam G, Shpun S, Cohen D, Ben-Haim SA. Atrial linear ablations in pigs. Chronic effects on atrial electrophysiology and pathology. Circulation. 1999;100(4):419–26.
Kobza R, Hindricks G, Tanner H, et al. Late recurrent arrhythmias after ablation of atrial fibrillation: incidence, mechanisms, and treatment. Heart Rhythm. 2004;1(6):676–83.
Hayashi H, Hayashi M, Miyauchi Y, et al. Left atrial wall thickness and outcomes of catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy. J Interv Card Electrophysiol. 2014;40(2):153–60.
Nakatani Y, Sakamoto T, Yamaguchi Y, Tsujino Y, Kataoka N, Kinugawa K. Heterogeneity in the left atrial wall thickness contributes to atrial fibrillation recurrence after catheter ablation. Heart Vessels. 2018;33(12):1549–58.
Beinart R, Abbara S, Blum A, et al. Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol. 2011;22(11):1232–6.
Tsutsui K, Mori H, Kawano D, et al. Ablation characteristics and incidence of steam pops with a novel, surface temperature-controlled ablation system in an ex vivo experimental model. Pacing Clin Electrophysiol. 2022;45(12):1390–400.
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MK, HM, and KH, study conception and design; MK and HM drafted the manuscript; AT, HK, RK, and KT data collection and data analysis; MF, MN, KK, and KA manuscript revision and study supervision.
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HM received lecture fees from Biosense Webster Japan and Boston Scientific Japan and also received grant support from Boston Scientific Japan and Abbott Medical Japan.
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Kuroda, M., Takeo, A., Kobayashi, H. et al. Influence of the irrigation flow pattern and catheter tip design on the lesion formation: an ex vivo experimental model. J Interv Card Electrophysiol 67, 589–597 (2024). https://doi.org/10.1007/s10840-023-01633-6
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DOI: https://doi.org/10.1007/s10840-023-01633-6