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Irrigated tip catheters for radiofrequency ablation in ventricular tachycardia.

Müssigbrodt A, Grothoff M, Dinov B, Kosiuk J, Richter S, Sommer P, Breithardt OA, Rolf S, Bollmann A, Arya A, Hindricks G - Biomed Res Int (2015)

Bottom Line: Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high.Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences.Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

View Article: PubMed Central - PubMed

Affiliation: Department of Electrophysiology, University Leipzig, Heart Centre, Strümpellstrasse 39, 04289 Leipzig, Germany.

ABSTRACT
Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

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Related in: MedlinePlus

Phase sensitive inversion recovery (PSIR) late Gadolinium enhancement (LGE) images in short axis (a; c) and 4-chamber view orientation (b; d). The first row (a; b) shows the images before ablation of ventricular tachycardia and premature ventricular contractions at the midventricular lateral wall. There is a large area of fibrosis at the inferior and inferolateral wall (arrows) from previous ablation. Images 1 day after ablation (c; d) show small linear transmural LGE (arrowheads) which is interpreted as postablational necrosis.
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fig1: Phase sensitive inversion recovery (PSIR) late Gadolinium enhancement (LGE) images in short axis (a; c) and 4-chamber view orientation (b; d). The first row (a; b) shows the images before ablation of ventricular tachycardia and premature ventricular contractions at the midventricular lateral wall. There is a large area of fibrosis at the inferior and inferolateral wall (arrows) from previous ablation. Images 1 day after ablation (c; d) show small linear transmural LGE (arrowheads) which is interpreted as postablational necrosis.

Mentions: While the clinical efficacy of open-irrigated RF catheters is well established in clinical practice, there have been studies demonstrating variable lesion depth, shape, and location based on the irrigant or saline “cloud” [5]. This feature of open irrigation is mainly dependent on local factors such as catheter position and tissue contact and direction and magnitude of blood flow. Closed-loop irrigated RF ablation provides tip cooling by internally circulating fluid and has been demonstrated to provide similar advantages in obtaining lesion depth while providing consistent lesion size that is not dependent on these factors. Open irrigation systems have nevertheless demonstrated greater interface cooling with lower incidence of both thrombus formation and steam pops than seen with closed-loop irrigated RF ablation [8]. Lesion formation after irrigated tip catheter ablation of VT and PVC (premature ventricular contractions) can be visualized by magnetic resonance imaging (Figure 1).


Irrigated tip catheters for radiofrequency ablation in ventricular tachycardia.

Müssigbrodt A, Grothoff M, Dinov B, Kosiuk J, Richter S, Sommer P, Breithardt OA, Rolf S, Bollmann A, Arya A, Hindricks G - Biomed Res Int (2015)

Phase sensitive inversion recovery (PSIR) late Gadolinium enhancement (LGE) images in short axis (a; c) and 4-chamber view orientation (b; d). The first row (a; b) shows the images before ablation of ventricular tachycardia and premature ventricular contractions at the midventricular lateral wall. There is a large area of fibrosis at the inferior and inferolateral wall (arrows) from previous ablation. Images 1 day after ablation (c; d) show small linear transmural LGE (arrowheads) which is interpreted as postablational necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4326034&req=5

fig1: Phase sensitive inversion recovery (PSIR) late Gadolinium enhancement (LGE) images in short axis (a; c) and 4-chamber view orientation (b; d). The first row (a; b) shows the images before ablation of ventricular tachycardia and premature ventricular contractions at the midventricular lateral wall. There is a large area of fibrosis at the inferior and inferolateral wall (arrows) from previous ablation. Images 1 day after ablation (c; d) show small linear transmural LGE (arrowheads) which is interpreted as postablational necrosis.
Mentions: While the clinical efficacy of open-irrigated RF catheters is well established in clinical practice, there have been studies demonstrating variable lesion depth, shape, and location based on the irrigant or saline “cloud” [5]. This feature of open irrigation is mainly dependent on local factors such as catheter position and tissue contact and direction and magnitude of blood flow. Closed-loop irrigated RF ablation provides tip cooling by internally circulating fluid and has been demonstrated to provide similar advantages in obtaining lesion depth while providing consistent lesion size that is not dependent on these factors. Open irrigation systems have nevertheless demonstrated greater interface cooling with lower incidence of both thrombus formation and steam pops than seen with closed-loop irrigated RF ablation [8]. Lesion formation after irrigated tip catheter ablation of VT and PVC (premature ventricular contractions) can be visualized by magnetic resonance imaging (Figure 1).

Bottom Line: Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high.Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences.Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

View Article: PubMed Central - PubMed

Affiliation: Department of Electrophysiology, University Leipzig, Heart Centre, Strümpellstrasse 39, 04289 Leipzig, Germany.

ABSTRACT
Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

Show MeSH
Related in: MedlinePlus