Key result
RF ablation applying an 'avoiding microbubbles' protocol resulted in lower power and temperature, fewer safety events, and more frequent transmural lesions compared to other protocols (P<0.001).
Why the study?
Does an 'avoiding microbubbles' radiofrequency ablation protocol improve energy profiles and lesion characteristics compared to continuous microbubble formation and temperature-guided protocols in adult mongrel dogs?
Does an 'avoiding microbubbles' radiofrequency ablation protocol improve energy profiles and lesion characteristics compared to continuous microbubble formation and temperature-guided protocols in adult mongrel dogs?
p-value: p=<0.001
An RF ablation protocol avoiding microbubbles is associated with higher safety and efficacy, including more frequent transmural lesions and fewer complications, compared to temperature-guided and continuous microbubble-formation protocols in a canine model.
Avoiding microbubbles may optimize RF ablation in preclinical models; leaves open clinical translation and human trials.
BACKGROUND: Radiofrequency (RF) energy parameters and chronic lesion characteristics associated with the microbubbles formation have not been yet fully elucidated. OBJECTIVES: The objective of this study was to compare the energy profiles and chronic lesion characteristics associated with RF ablation of the pulmonary vein antrum using three different ablation protocols: (1) avoiding microbubbles; (2) continuous microbubble formation; (3) temperature-guided ablation. METHODS: A 4-mm tip ablation catheter was used for creating RF ablation lesions in 15 adult mongrel dogs. All ablation lesions were created at the posterior aspect of the PV antrum in each animal. Avoiding microbubbles (group 1, n = 5 dogs, 23 lesions), continuous microbubble formation (group 2, n = 5 dogs, 22 lesions), and temperature-guided (group 3, n = 5 dogs, 19 lesions, target temperature 60 degrees C/power limit 50 W) ablation lesions were analyzed. RESULTS: Group 1 showed significantly lower power (19 +/- 8.6 W), lower temperature (50 +/- 4.8 degrees C), higher efficiency-of-heating index (2.9 +/- 0.8 degrees C/W), and lower impedance (109 +/- 24.4 Omega) than groups 2 (38 +/- 8.4 W; 63 +/- 10 degrees C; 1.8 +/- 0.8 degrees C/W; 148 +/- 34.4 Omega) and 3 (44 +/- 12 W; 57 +/- 2.4 degrees C; 1.4 +/- 0.5 degrees C/W; 139 +/- 23.1 Omega) (P < 0.001 vs groups 2 and 3). During ablation, no significant events were detected in group 1, but 11 cases of audible pop, 11 cases of catheter tip charring, and 1 case of fatal myocardial perforation were observed in groups 2 and 3. Transmural lesions were more frequently created in group 1. CONCLUSION: RF energy delivery applying "avoiding microbubbles" protocol seems to be associated with higher degree of safety and efficacy when compared to temperature-guided and continuous microbubble-formation ablation protocols.
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Oh et al. (2005) studied Radiofrequency left atrial ablation (n=15). Avoiding microbubbles protocol vs. Continuous microbubble formation and temperature-guided ablation protocols was evaluated on Energy profiles (power, temperature, efficiency-of-heating index, impedance) and chronic lesion characteristics (p=<0.001). RF ablation applying an 'avoiding microbubbles' protocol resulted in lower power and temperature, fewer safety events, and more frequent transmural lesions compared to other protocols (P<0.001).
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