Efficacy of multiple ring and coil electrode radiofrequency ablation catheters for the creation of long linear lesions in the atria

Background: The tissue selectivity of pulsed field ablation (PFA) provides safety advantages over radiofrequency ablation in treating atrial fibrillation. One-shot PFA catheters have been shown capable of performing pulmonary vein isolation, but not flexible lesion sets such as linear lesions. A novel lattice-tip ablation catheter with a compressible 9-mm nitinol tip is able to deliver either focal radiofrequency ablation or PFA lesions, each in 2 to 5 s. Methods: In a 3-center, single-arm, first-in-human trial, the 7.5F lattice catheter was used with a custom mapping system to treat paroxysmal or persistent atrial fibrillation. Toggling between energy sources, point-by-point pulmonary vein encirclement was performed using biphasic PFA posteriorly and either temperature-controlled irrigated radiofrequency ablation or PFA anteriorly (RF/PF or PF/PF, respectively). Linear lesions were created using either PFA or radiofrequency ablation. Results: The 76-patient cohort included 55 paroxysmal and 21 persistent atrial fibrillation patients undergoing either RF/PF (40 patients) or PF/PF (36 patients) ablation. The pulmonary vein isolation therapy duration time (transpiring from first to last lesion) was 22.6±8.3 min/patient, with a mean of 50.1 RF/PF lesions/patient. Linear lesions included 14 mitral (4 RF/2 RF+PF/8 PF), 34 left atrium roof (12 RF/22 PF), and 44 cavotricuspid isthmus (36 RF/8 PF) lines, with therapy duration times of 5.1±3.5, 1.8±2.3, and 2.4±2.1 min/patient, respectively. All lesion sets were acutely successful, using 4.7±3.5 minutes of fluoroscopy. There were no device-related complications, including no strokes. Postprocedure esophagogastroduodenoscopy revealed minor mucosal thermal injury in 2 of 36 RF/PF and 0 of 24 PF/PF patients. Postprocedure brain magnetic resonance imaging revealed diffusion-weighted imaging+/fluid-attenuated inversion recovery- and diffusion-weighted imaging+/fluid-attenuated inversion recovery+ asymptomatic lesions in 5 and 3 of 51 patients, respectively. Conclusions: A novel lattice-tip catheter could safely and rapidly ablate atrial fibrillation using either a combined RF/PF approach (capitalizing on the safety of PFA and the years of experience with radiofrequency energy) or an entirely PF approach. Registration: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT04141007 and NCT04194307.

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The Cutting Edge of Atrial Fibrillation Ablation

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2020.40 ◽

2021 ◽

Vol 10 (2) ◽

pp. 101-107

Author(s):

Maya S Verma ◽

Maria Terricabras ◽

Atul Verma

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Short Duration ◽

High Power ◽

Irreversible Electroporation ◽

Cutting Edge ◽

Atrial Fibrillation Ablation ◽

The Creation ◽

The Way

This article describes the advances in catheter ablation for AF that have allowed the creation of more durable and efficient lesions. It describes advances in high-power, short-duration radiofrequency ablation, radiofrequency balloon devices, ultra-low cryoablation and irreversible electroporation. It also considers the way these devices may change the way catheter ablation is performed for AF.

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Translesion stimulus-excitation delay indicates quality of linear lesions produced by radiofrequency ablation in rabbit hearts

Physiological Measurement ◽

10.1088/0967-3334/28/6/001 ◽

2007 ◽

Vol 28 (6) ◽

pp. 611-623 ◽

Cited By ~ 5

Author(s):

Herman D Himel IV ◽

John H Dumas ◽

Andy C Kiser ◽

Stephen B Knisley

Keyword(s):

Radiofrequency Ablation ◽

Linear Lesions

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Performance of a Novel Bipolar/Monopolar Radiofrequency Ablation Device on the Beating Heart in an Acute Porcine Model

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a77f2b ◽

2013 ◽

Vol 8 (4) ◽

pp. 276-283 ◽

Cited By ~ 9

Author(s):

Lindsey L. Saint ◽

Christopher P. Lawrance ◽

Shoichi Okada ◽

Toshinobu Kazui ◽

Jason O. Robertson ◽

...

Keyword(s):

Cardiac Output ◽

Radiofrequency Ablation ◽

Cross Sections ◽

Left Atrial ◽

Beating Heart ◽

Tissue Thickness ◽

Linear Lesions ◽

Anatomic Location ◽

The Cross ◽

The Right

Objective Although the advent of ablation technology has simplified and shortened surgery for atrial fibrillation, only bipolar clamps have reliably been able to create transmural lesions on the beating heart. Currently, there are no devices capable of reproducibly creating the long linear lesions in the right and left atria needed to perform a Cox-Maze procedure. This study evaluated the performance of a novel suction-assisted radiofrequency device that uses both bipolar and monopolar energy to create lesions from an epicardial approach on the beating heart. Methods Six domestic pigs underwent median sternotomy. A dual bipolar/monopolar radiofrequency ablation device was used to create epicardial linear lesions on the superior and inferior vena cavae, the right and left atrial free walls, and the right and left atrial appendages. The heart was stained with 2,3,5-triphenyl-tetrazolium chloride, and each lesion was cross-sectioned at 5-mm intervals. Lesion depth and transmurality were determined. Results Transmurality was documented in 94% of all cross sections, and 68% of all ablation lines were transmural along their entire length. Tissue thickness was not different between the transmural and nontransmural cross sections (3.1 ± 1.3 and 3.4 ± 2.1, P = 0.57, respectively), nor was the anatomic location on the heart ( P = 0.45 for the distribution). Of the cross sections located at the end of the ablation line, 11% (8/75) were found to be nontransmural, whereas only 4% (8/195) of the cross sections located within the line of ablation were found to be nontransmural ( P = 0.04). Logistic regression analysis demonstrated that failure of the device to create transmural lesions was associated with low body temperature ( P = 0.006) but not with cardiac output ( P = 0.54). Conclusions This novel device was able to consistently create transmural epicardial lesions on the beating heart, regardless of anatomic location, cardiac output, or tissue thickness. The performance of this device was improved over most devices previously tested but still falls short of ideal clinical performance. Transmurality was lower at the end of the lesions, highlighting the importance of overlapping lines of ablation in the clinical setting.

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Transmembraneous Irrigation of Multipolar Radiofrequency Ablation Catheters: Induction of Linear Lesions Encircling the Pulmonary Vein Ostium Without the Risk of Coagulum Formation?

Journal of Interventional Cardiac Electrophysiology ◽

10.1023/b:jice.0000026913.46734.04 ◽

2004 ◽

Vol 10 (3) ◽

pp. 199-209 ◽

Cited By ~ 10

Author(s):

Christian Weiss ◽

Mark Stewart ◽

Olaf Franzen ◽

Thomas Rostock ◽

Jan Becker ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Pulmonary Vein ◽

Linear Lesions ◽

Pulmonary Vein Ostium

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The role of affect in feelings of obligation

Behavioral and Brain Sciences ◽

10.1017/s0140525x19002449 ◽

2020 ◽

Vol 43 ◽

Author(s):

Stefen Beeler-Duden ◽

Meltem Yucel ◽

Amrisha Vaish

Keyword(s):

Positive Emotions ◽

The Creation ◽

Sense Of Obligation

Abstract Tomasello offers a compelling account of the emergence of humans’ sense of obligation. We suggest that more needs to be said about the role of affect in the creation of obligations. We also argue that positive emotions such as gratitude evolved to encourage individuals to fulfill cooperative obligations without the negative quality that Tomasello proposes is inherent in obligations.

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