Key result
Hot-balloon ablation in a porcine model shows tissue temperature inversely correlates with distance from the balloon.
Why the study?
Despite clinical evidence for hot-balloon ablation in AF, the actual tissue temperature and heating mechanisms had not been clarified.
In a porcine model, hot-balloon ablation at 70-73°C achieved lethal tissue temperatures (>50°C) up to a distance of 3.6 mm from the balloon surface, supporting its clinical efficacy and safety.
Answers are grounded in this paper and cite their sources.
Porcine findings warrant caution against clinical adoption; extends preclinical evidence on thermal lesion depth for hot-balloon ablation.
INTRODUCTION: Hot-balloon ablation depends solely on thermal conduction, and myocardial tissue is ablated by only conductive heating from the balloon surface. Despite growing clinical evidence of the efficacy and safety of hot-balloon ablation for atrial fibrillation (AF), the actual tissue temperature and the mechanism of heating during such ablation has not been clarified. To determine, by means of a porcine study, the temperatures of tissues targeted during hot-balloon ablation of AF performed with hot-balloon set temperatures of 73°C or 70°C, in accordance with the temperatures now used clinically. METHODS: After a right thoracotomy, thermocouples with markers were implanted epicardially on the superior vena cava (SVC) and pulmonary veins (PVs) in six pigs. The tissue temperatures during hot-balloon ablation (balloon set temperatures of 73°C and 70°C, 180 s/PV) were recorded, and the maximum tissue temperatures and fluoroscopically measured distance from the balloon surface to the target tissues were assessed. RESULTS: Sixteen SVC- and 18 PV-targeted energy deliveries were performed. Full-thickness circumferential PV lesions were created with all hot-balloon applications. A significant inverse relation was found between the recorded tissue temperatures and distance (r = -.67; p < .001) from the balloon surface. No tissue temperature exceeded either of the balloon set temperatures. The best distance cutoff value for achieving lethal tissue temperatures more than 50°C was 3.6 mm. CONCLUSION: The hot-balloon set temperature, energy delivery time, and tissue temperature data obtained in this porcine study supported the clinical efficacy and safety of the hot-balloon ablation as currently practiced in patients with AF.
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Nakahara et al. (2020) studied Atrial fibrillation ablation model (n=6). Hot-balloon ablation was evaluated on Relation between recorded tissue temperatures and distance from the balloon surface (r = -0.67, p=< .001). Hot-balloon ablation in a porcine model demonstrated a significant inverse relation between tissue temperature and distance from the balloon surface (r = -0.67; p < 0.001).
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