Author + information
- Received April 23, 2019
- Revision received August 19, 2019
- Accepted August 20, 2019
- Published online October 30, 2019.
- Eran Leshem, MD, MHAa,
- Israel Zilberman, DVMb,
- Michael Barkagan, MDa,
- Ayelet Shapira-Daniels, MDa,
- Jakub Sroubek, MD, PhDa,
- Assaf Govari, PhDb,
- Alfred E. Buxton, MDa and
- Elad Anter, MDa,∗ ()
- aHarvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- bBiosense Webster, Advanced Research and Development, Haifa, Israel
- ↵∗Address for correspondence:
Dr. Elad Anter, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Baker 4, Boston, Massachusetts 02215.
Objectives The goal of this study was to examine the safety and efficacy of radiofrequency ablation (RFA) with irrigated catheters operated in a temperature-controlled mode for ventricular ablation.
Background Techniques to increase RFA dimensions are associated with higher risk for steam-pops. A novel irrigated catheter with circumferential thermocouples embedded in its ablation surface provides real-time surface temperature data. This study hypothesized that RFA operated in a temperature-controlled mode may allow maximizing lesion dimensions while reducing the occurrence of steam-pops.
Methods RFA with an irrigated catheter incorporating surface thermocouples was examined in 6 swine thigh muscle preparations and 15 beating ventricles at higher (50 W/60 s, Tmax50oC) and lower (50 W/60 s, Tmax45oC) temperature limits. Biophysical properties, lesion dimensions, and steam-pop occurrence were compared versus RFA with a standard catheter operated in power-control mode at higher (50 W/60 s) and lower (40W/60 s) power, and additionally at high power with half-normal saline (50 W/60 s).
Results In the thigh muscle preparation, lesion depth and width were similar between all groups (p = 0.9 and p = 0.17, respectively). Steam-pops were most frequent with power-controlled ablation at 50 W/60 s (82%) and least frequent with temperature-controlled ablation at 50 W/60 s, Tmax45oC (0%; p < 0.001). In the beating ventricle, lesion depth was comparable between all RFA settings (p = 0.09). Steam-pops were most frequent using power-controlled ablation at 50 W/60 s (37%) and least frequent with temperature-controlled ablation at 50 W/60 s, Tmax45oC (7%; p < 0.001). Half-normal saline had no incremental effect on lesion dimensions at 50 W in either the thigh muscle or the beating heart.
Conclusions RFA using a novel irrigated catheter with surface thermocouples operated in a temperature-controlled mode can maximize lesion dimensions while reducing the risk for steam-pops.
This study was partly supported by an investigator-initiated grant from Biosense Webster. Dr. Anter has received research grants from Biosense Webster and honoraria from Boston Scientific. Drs. Zilberman and Govari are employees of Biosense Webster. Dr. Shapira-Daniels has received a National Institutes of Health T32 grant. Dr. Buxton received honoraria from Boston Scientific (nonsignificant) in 2018 and 2017. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 23, 2019.
- Revision received August 19, 2019.
- Accepted August 20, 2019.
- 2019 American College of Cardiology Foundation
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