Key result
A novel articulated bilimb RF ablation catheter successfully created fully transmural lesions in up to 86% of attempts at 55-75 W in sheep atria, significantly reducing electrogram amplitude (P=0.001).
Why the study?
Does a novel articulated bilimb RF ablation catheter effectively and safely create fully transmural linear lesions in the right atrium of sheep?
Does a novel articulated bilimb RF ablation catheter effectively and safely create fully transmural linear lesions in the right atrium of sheep?
A novel articulated bilimb RF ablation catheter successfully created continuous and fully transmural linear lesions in the right atrium of sheep, demonstrating potential as a tool for ablation of atrial fibrillation and flutter.
Should not change clinical ablation practice; leaves open human translation of articulated bilimb catheters for transmural lesions.
Transcatheter radiofrequency (RF) ablation of atrial fibrillation or flutter requires the creation of linear lesions. However, conventional catheters are not predictably effective because of poor endocardial contact, and limited lesion size and penetration. The purpose of the study was to assess in the right atrium, the efficacy and safety of a new catheter designed to create long myocardial tissue lesions using RF energy. The main characteristics of this 8 Fr deflectable RF ablation catheter were: (1) a perpendicularly contacting articulated bilimb electrodes ensuring stable and firm endocardial firm contact; and (2) an irrigated planar interface. Three different electrode prototypes were tested. Fourteen anesthetized sheep weighing 61 +/- 7 kg underwent RF ablation in the right atrium using three incremental power levels (25 to 45, 50, 55 to 75 W) with the aim of creating fully transmural (FT) lesions, defined as continuous and complete epicardial and endocardial lesion imprints. The animals were euthanized 1 hour later for macroscopic and histologic examinations. Forty-three of the 80 right atrial lesions created, in smooth as well as in trabeculated areas, were FT. The percentage of FT lesions increased with the applied power from 37% with 25-45 W, to 49% with 50 W, and up to 86% for 55-75 W. In all but two cases, histologic examination showed no discontinuity between FT lesions produced by both limbs resulting in 19 coalescent linear lesions with an average size of 25 x 6 x 4 mm (length x width x depth). In situ bipolar electrograms after ablation in the FT group showed split potentials and/or a marked decrease in amplitude from 2.85 +/- 1.79 to 0.33 +/- 0.14 mV (P = 0.001) accompanied by near complete disappearance of unipolar electrograms. There was no perforation due to RF ablation. In conclusion, continuous and FT lesions can be achieved in various areas of sheep atria, including the trabecular right atrium, with a perpendicularly contacting bilimb electrode catheter. It represents a promising tool for catheter ablation of atrial fibrillation and flutter.
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Lavergne et al. (1998) studied Atrial fibrillation or flutter (n=14). Articulated bilimb RF ablation catheter was evaluated on Creation of fully transmural (FT) lesions. A novel articulated bilimb RF ablation catheter successfully created fully transmural lesions in up to 86% of attempts at 55-75 W in sheep atria, significantly reducing electrogram amplitude (P=0.001).
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