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June 19, 2013Journal of Cardiovascular Electrophysiology

Visualizing Intramyocardial Steam Formation with a Radiofrequency Ablation Catheter Incorporating Near‐Field Ultrasound

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Why the study?

Does a radiofrequency ablation catheter incorporating near-field ultrasound visualize intramyocardial gas formation prior to steam pops in an ovine model?

Population

In vivo open-chest ovine model (n=9) with 86 lesions delivered to the epicardial surface of the ventricles.

Design

Preclinical, Blinded observer compared ultrasound image to digital audio…

Authors

MWMatthew WrightElectrophysiologyEHErik HarksSt Thomas' HospitalSDS. DeladiPhilips (Netherlands)

Discussion

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Implication

May enable preemptive steam pop avoidance during ablation; leaves open human translation and clinical validation.

Key Points

  • To determine if near-field ultrasound integrated into a radiofrequency ablation catheter can visualize intramyocardial gas formation before a steam pop occurs.
  • Conducted an in vivo open-chest ovine model study (n = 9) delivering 86 radiofrequency ablation lesions to the ventricular epicardial surface for 15–60 seconds.
  • Blinded observers compared real-time catheter-based ultrasound imaging against digital audio recordings acquired from within the pericardium.
  • Audible steam pops occurred in 28 of 86 lesions, with higher mean delivered power in pop lesions versus non-pop lesions (n = 58; 8.0 ± 1.8 W vs 6.7 ± 2.0 W, P = 0.006).
  • Tissue ultrasound contrast changes indicating gas formation appeared in 100% of steam pop lesions, appearing 7.9 ± 6.2 seconds before audible pops and 7.6 ± 7.2 seconds before impedance rise.
  • Elective termination of radiofrequency energy following ultrasound contrast changes successfully prevented steam pops in 4 ablation attempts.

Structured PICO

Does a radiofrequency ablation catheter incorporating near-field ultrasound visualize intramyocardial gas formation prior to steam pops in an ovine model?

P
Population
In vivo open-chest ovine model (n=9) with 86 lesions delivered to the epicardial surface of the ventricles.
I
Intervention
Radiofrequency ablation using a catheter incorporating near-field ultrasound, with energy delivered for 15-60 seconds.
O
Outcome
Visualization of intramyocardial gas formation (change in US contrast) prior to a steam pop.surrogate

Integrating near-field ultrasound into an RF ablation catheter allows visualization of intramyocardial gas formation several seconds before a steam pop occurs, potentially preventing complications.

Cite This Study

Wright et al. (2013) studied this question.

synapsesocial.com/papers/6a7cf581c502fdf5e0394501https://doi.org/10.1111/jce.12218

Topics

AF ablation outcomes
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Popping Phenomena in Temperature‐Controlled Radiofrequency Ablation: When and Why Do They Occur?2000 · 78 citations
  2. 2Temperature Guided Radiofrequency Catheter Ablation of Myocardium: Comparison of Catheter Tip and Tissue Temperatures In Vitro1997 · 59 citations
  3. 3Cellular electrophysiological effects of hyperthermia on isolated guinea pig papillary muscle. Implications for catheter ablation.1993 · 307 citations
  4. 4Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation2005 · 1,321 citations
  5. 5Novel Contact Force Sensor Incorporated in Irrigated Radiofrequency Ablation Catheter Predicts Lesion Size and Incidence of Steam Pop and Thrombus2008 · 636 citations