Unexpected Lattice-Tip Catheter Overheating During Pulsed Electric Field Ablation Near Metal Implants

Figures

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  Figure 1. Catheter Position Associated With Temperature Rise and Corresponding Temperature Change (Case 1) During an application near the right superior pulmonary vein, the catheter temperature increased to 61 °C. (Top Left) The white dotted line indicates the estimated location of the occluder. (Bottom Left) On intracardiac echocardiography, the lattice-tip catheter was in proximity to the occluder (arrowheads), and no abnormal bubble stream was observed during the application. (Bottom Right) Left atrial access was successfully achieved by traversing an occluder using a steerable sheath.

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  Figure 2. Catheter Position Associated With Temperature Rise and Corresponding Temperature Change (Cases 2 and 3) (A) Case 2: A temperature rise to 68 °C without a concomitant impedance change was observed during an application at the ridge between the left superior pulmonary vein and the left atrial appendage. On fluoroscopy, the catheter position where the temperature rise occurred was close to the AtriClip. (B) Case 3: During a pulsed-field energy application delivered immediately beneath the pulmonary Sapien valve, the catheter temperature increased to 53 °C without a concomitant change in impedance. On fluoroscopy, the Sphere-9 catheter was positioned directly beneath the Sapien valve.

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  Visual Summary. Unexpected Overheating of the Lattice-Tip Catheter During or After Pulsed Electric Field Energy Delivery in the Vicinity of Metal Implantable Devices