Real-time intracardiac echocardiography validation of saline-enhanced radiofrequency needle-tip ablation: lesion characteristics and gross pathology correlation
| Autor: | Songyun Wang, Michael G. Curley, Kristi H. Monahan, Douglas L. Packer, Atsushi Suzuki, Kimitake Imamura, Maryam E. Rettmann, Kay D. Parker, H. Immo Lehmann, Laura K. Newman, Jannis Dickow |
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| Rok vydání: | 2021 |
| Předmět: |
Radiofrequency ablation
medicine.medical_treatment 030204 cardiovascular system & hematology law.invention Gross examination Lesion 03 medical and health sciences Dogs 0302 clinical medicine law Interquartile range Physiology (medical) Animals Humans Medicine Endocardium business.industry Myocardium Ablation Catheter Echocardiography Needles Catheter Ablation Microbubbles medicine.symptom Cardiology and Cardiovascular Medicine business Nuclear medicine Pericardium 030217 neurology & neurosurgery |
| Zdroj: | EP Europace. 23:1826-1836 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/euab121 |
| Popis: | Aims With the implementation of saline-enhanced radiofrequency (SERF) needle-tip ablation, real-time validation of lesion formation is needed for the controllable creation of transmural lesions. The aim of the study was to analyse the ability of two-dimensional intracardiac echocardiography (2D-ICE) to guide and validate SERF ablation in real-time. Methods and results Fifty-six SERF energy deliveries at left ventricular sites of 11 dogs guided by 2D-ICE were analysed (power: 15–50 W; time: 25–120 s; irrigation saline: 60°C with 10 mL/min flow rate). Catheter tip/tissue orientation and lesion formation could be well detected by 2D-ICE in 49 (87.5%) energy deliveries. Gross pathology analysis confirmed excellent 2D-ICE lesion localization, the ability to detect transmural lesions (70% sensitivity, 47% specificity) and positive correlation between 2D-ICE and the corresponding gross pathology measurements of ‘maximal lesion depth’; (repeated measures correlation: rrm = 0.43, P = 0.012) and ‘depth at maximal lesion width’ (D@MW; rrm = 0.51, P = 0.003). The median angle between SERF catheter tip and endocardium was 76° [interquartile range (IQR) 58–83°]. The more perpendicular the catheter tip/tissue orientation was the deeper D@MW (rrm = 0.32, P = 0.045). Grade 3 microbubbles on 2D-ICE during ablation, indicating inadequate catheter tip/tissue contact, was associated with smaller lesion volumes than with Grade 1 microbubbles (284.8 mm3 [IQR 151.3–343.1] vs. 2114.1 mm3 [IQR 1437.0–3026.3], P Conclusion With excellent lesion localization and a 70% detection rate of transmural lesions, 2D-ICE is well suited to validate SERF ablation lesion formation in real-time. The catheter tip/tissue angle impacts the lesion formation and through perpendicular catheter positioning, deeper intramural areas of the myocardium can be reached. |
| Databáze: | OpenAIRE |
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