Catheter orientation affects superficial and maximal lesion length in vitro, while during clinical PVI procedures, orientation is mostly parallel to the endocardium (mean contact angle 28 ± 20°).
Observational (n=21)
Does ablation catheter orientation affect lesion size in vitro and how does it vary during pulmonary vein isolation in vivo?
Catheter orientation significantly impacts radiofrequency lesion length but not depth or width in vitro, and tends to be mostly parallel during clinical pulmonary vein isolation.
BACKGROUND: Catheter-delivered radiofrequency (RF) lesion formation is a complex phenomenon, and few studies have explored the effect of catheter orientation on lesion size and catheter orientation behavior during pulmonary vein isolation (PVI) procedures. We evaluated the influence of catheter orientation on lesion dimensions in an in vitro experimental setting and investigated the catheter orientation behavior during PVI. METHODS AND RESULTS: 72 lesions were created in vitro on a porcine heart using a contact force catheter in a parallel, oblique, and perpendicular tip to tissue orientation. The superficial lesion length (SLL) increased shifting the catheter from perpendicular to parallel orientation. The intratissue absolute maximal lesion length (AML) was greater with an oblique catheter orientation. The lesion depth (LD) and the superficial lesion width (SLW) resulted similar with any orientation. Data from 21 PVI procedures in patients with paroxysmal atrial fibrillation using the "wide antral circumferential RF ablation" (WACA) technique were retrospectively analyzed. The mean contact angle among 1130 RF lesions was 28 ± 20°. A prevalent parallel orientation was noted in the anterior WACA segments, whereas it resulted more perpendicular in the posterior segments. Significant differences in catheter orientation between the three operators were found only in few WACA segments. CONCLUSIONS: In an in vitro setting, catheter orientation affects SLL and AML, but not LD and SLW. During PVI procedures, catheter orientation resulted mostly parallel to the endocardium. Catheter orientation varied among different WACA segments, but only small differences were found between three operators when considering similar WACA segments.
Calzolari et al. (Wed,) conducted a observational in paroxysmal atrial fibrillation (n=21). Catheter orientation was evaluated on Lesion dimensions and catheter orientation behavior. Catheter orientation affects superficial and maximal lesion length in vitro, while during clinical PVI procedures, orientation is mostly parallel to the endocardium (mean contact angle 28 ± 20°).