Key result
Including intramyocardial blood perfusion in computer models of 60-second radiofrequency cardiac ablation reduced computed lesion depth by 0.45 to 1 mm compared to models ignoring perfusion.
Why the study?
Does including intramyocardial blood perfusion in computer modeling affect the computed thermal lesion depth during radiofrequency cardiac ablation?
Does including intramyocardial blood perfusion in computer modeling affect the computed thermal lesion depth during radiofrequency cardiac ablation?
Intramyocardial blood perfusion acts as a heat sink during radiofrequency cardiac ablation and should be included in computer models for ablations lasting >1 minute to accurately predict lesion depth.
Models ignoring perfusion overestimate lesion depth; hypothesis-generating for ablation simulations and requires in vivo validation before clinical use.
PURPOSE: The thermal effect of the intramyocardial blood perfusion on the size of lesions created by radiofrequency cardiac ablation (RFCA) has not been adequately studied to date. Our objective was to assess the impact of including this phenomenon in RFCA computer modelling in terms of the thermal lesion depth created. METHODS: A computer model was built and computer simulations were conducted to assess the effect of including the blood perfusion term in the bioheat equation. This term mimics the intramyocardial blood flow (i.e., blood perfusion) in the cardiac wall at the site at which the RFCA is being conducted and hence represents a heat removing mechanism. When considered, blood perfusion rates ranged from 609 to 1719 ml/min/kg. Two electrode design and modes were considered: a non-irrigated electrode with constant temperature mode and an irrigated electrode with constant power mode. RESULTS: All the depths computed without including the blood perfusion term were larger than those that did include it, regardless of perfusion rate. The differences in lesion depth between ignoring and including blood perfusion increased over time; for a 60 s RFCA they were 0.45 and 1 mm for minimum and maximum perfusion rate, respectively. The differences were more or less independent of blood flow in the cardiac chamber, electrode type and ablation mode. CONCLUSIONS: The findings suggest that the heat-sink effect of blood perfusion should be taken into account in the case of ablations (>1 minute) such as those conducted in RFCA of the ventricular wall.
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Pérez et al. (2017) studied Radiofrequency cardiac ablation. Including intramyocardial blood perfusion in computer modelling vs. Ignoring blood perfusion was evaluated on Thermal lesion depth. Including intramyocardial blood perfusion in computer models of 60-second radiofrequency cardiac ablation reduced computed lesion depth by 0.45 to 1 mm compared to models ignoring perfusion.
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