Impact of epicardial adipose tissue and catheter ablation strategy on biophysical parameters and ablation lesion characteristics

Autor:	Lijun Zheng, Duy T. Nguyen, Justin A. Edward, Ryan T. Borne, Matthew M. Zipse, Wendy S. Tzou, William H. Sauer
Rok vydání:	2020
Předmět:	Time Factors Radiofrequency ablation Heart Ventricles medicine.medical_treatment Operative Time Adipose tissue Catheter ablation In Vitro Techniques 030204 cardiovascular system & hematology Cardiac Catheters law.invention Lesion 03 medical and health sciences 0302 clinical medicine law Physiology (medical) medicine Animals 030212 general & internal medicine Therapeutic Irrigation Saline Adiposity business.industry Myocardium Equipment Design Ablation Catheter Adipose Tissue Catheter Ablation Cattle medicine.symptom Cardiology and Cardiovascular Medicine business Nuclear medicine Pericardium Ex vivo
Zdroj:	Journal of Cardiovascular Electrophysiology. 31:1114-1124
ISSN:	1540-8167 1045-3873
DOI:	10.1111/jce.14383
Popis:	Epicardial adipose (EA) tissue may limit effective radiofrequency ablation (RFA).We sought to evaluate the lesion formation of different ablation strategies on ventricular myocardium with overlying EA.Bovine myocardium with EA was placed in a circulating saline bath in an ex vivo model. Open-irrigated (OI) RFA was performed, parallel to the myocardium, over fat at 50 W for variable RF durations, variable contact force, catheter configurations (unipolar RF vs bipolar RF), and catheter irrigants (normal saline vs half-normal saline). Ablation was also performed with a needle-tipped ablation catheter (NTAC), perpendicular to the myocardium.Increasingly thick EA attenuated lesion size regardless of ablation strategy. RF applied with longer durations and increasing CF produced larger lesion volumes and deeper lesions with ablation over EA more than 3 mm but was unable to produce measurable lesions when EA less than 3 mm. Similarly, ablation with half normal saline irrigant created slightly deeper lesions than bipolar RF and unipolar RF with normal saline as EA thickness increased, but was unable to produce measurable lesions when EA more than 3 mm. Of all ablation strategies, only NTAC produced effective lesion volumes when ablating over thick (3 mm) EA.While EA attenuates lesion depth and size, relatively larger, and deeper lesions can be achieved with longer RFA duration, higher CF, half normal saline irrigant, and, to a greater extent, by utilizing bipolar RF or NTAC, but only over thin adipose (3 mm). Of those catheters/strategies tested, only NTAC was able to effectively deliver RF over thick (3 mm) EA with this model.
Databáze:	OpenAIRE
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