What question did this study set out to answer?

To characterize and compare lesion geometry, impedance rises, and crater/coagulum formation across multiple cooled and noncooled radiofrequency ablation catheter systems.

June 30, 2003Pacing and Clinical Electrophysiology

Radiofrequency Catheter Ablation:

Q: What does this research mean for the field?

Irrigated radiofrequency catheter systems are the most effective for creating deep and long myocardial lesions while minimizing impedance rise and thrombus formation compared to internally cooled and large-tip catheters. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Why the study?

Do cooled catheter systems improve lesion geometry and reduce impedance rise and coagulum formation compared to noncooled catheters in isolated porcine myocardium?

Population

Isolated porcine myocardium superfused with heparinized pig blood (37 degrees C)

Comparison

Three cooled catheter systems: two saline… vs Noncooled catheters with a large tip electrode…

Design

Preclinical

Authors

UDUwe DorwarthMünchen Klinik Bogenhausen MFMichael FiekHelios Kliniken TRT. RempAsklepios

Discussion

Member takes

Implication

Irrigated systems may yield superior lesions in animal models; leaves open translation to clinical AF/VT ablation.

Key Points

To characterize and compare lesion geometry, impedance rises, and crater/coagulum formation across multiple cooled and noncooled radiofrequency ablation catheter systems.
Tested five 7 Fr catheter configurations: two saline-irrigated (showerhead-type sprinkler and porous metal tip), one internally cooled, one 8-mm large-tip, and one 4-mm standard tip.
Delivered radiofrequency energy at 10–40 W to isolated porcine myocardium superfused with heparinized pig blood at 37 °C.
Both irrigated systems generated large lesion depth (8.1 ± 1.6 mm) and diameter (13.8 ± 1.6 mm), with internally cooled catheters showing smaller diameter (12.3 ± 1.2 mm, P = 0.04) and large-tip catheters showing smaller depth (6.3 ± 1.0 mm, P = 0.002).
Power requirements to achieve maximum lesion size were three-fold higher for irrigated systems and two-fold higher for internally cooled and large-tip catheters compared to standard tips.
Impedance rises occurred least frequently with irrigated and large-tip catheters, with crater formation occurring in 61–93% of impedance rise events, while irrigated systems most effectively prevented coagulum formation.

Structured PICO

Do cooled catheter systems improve lesion geometry and reduce impedance rise and coagulum formation compared to noncooled catheters in isolated porcine myocardium?

Population

Isolated porcine myocardium superfused with heparinized pig blood (37 degrees C)

Intervention

Three cooled catheter systems (7 Fr, 4-mm tip): two saline irrigation catheters (sprinkler and porous metal tip) and an internally cooled catheter, delivering RF energy at 10-40 W

Comparator

Noncooled catheters (7 Fr) with a large tip electrode (8 mm) and a standard tip electrode (4 mm)

Outcome

Lesion geometry (depth, diameter, volume), incidence of impedance rise, and crater and coagulum formationsurrogate

Irrigated catheter ablation creates deep and long lesions with a low rate of impedance rise and thrombus formation compared to internally cooled or noncooled catheters in an ex vivo porcine model.

Cite This Study

Dorwarth et al. (2003) studied this question.

synapsesocial.com/papers/6a1a0d033f3ec013f0df6b6d https://doi.org/10.1046/j.1460-9592.2003.t01-1-00208.x

Topics

AF ablation outcomes

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Radiofrequency Catheter Ablation:

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Radiofrequency Catheter Ablation:

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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