Biparietal bidirectional bipolar radiofrequency in hybrid cardiac ablation: an in vitro evaluation

Francesco Matteucci*, Bart Maesen, Carlo De Asmundis, Elham Bidar, Linda Micali, Gianmarco Parise, Jos G. Maessen, Mark La Meir, Sandro Gelsomino

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: The aim of this study was to evaluate the lesion size and depth of radiofrequency (RF) ablation in a simultaneous biparietal bidirectional bipolar (SBB) approach, compared to a simultaneous and staged unipolar and uniparietal bipolar setup [simultaneous uniparietal bipolar (SiUB) and staged uniparietal bipolar (StUB), respectively].

METHODS: Fresh left atrial porcine tissue was mounted into the ABLA-BOX simulator. Different ablation approaches were tested: (i) SBB: a concept consisting of SBB endo-epicardial ablation, (ii) SiUB: simultaneous epicardial uniparietal bipolar and endocardial unipolar ablation and (iii) StUB: staged epicardial uniparietal bipolar and endocardial unipolar ablation. In the StUB setup, a 1-h interval between the epi-endo ablation was respected.

RESULTS: Transmural lesions were present in 90% of the bipolar biparietal ablations, yet no full transmurality was observed in the simultaneous nor in the staged unipolar with uniparietal bipolar ablation group. In SBB, the area and volume of the ablation lesions were smaller (523.33 mm(2)/mm and 52.33 mm(3)/mm, respectively) than in SiUB (588.17 mm(2)/mm and 58.81 mm(3)/mm, respectively) and StUB (583.76 mm(2)/mm and 58.37 mm(3)/mm, P=0.044). Also, in SBB, the overall, epicardial and endocardial maximum diameters of the lesions (1.59, 1.57 and 1.52 mm; respectively) were smaller than in SiUB (2.38, 2.26 and 2.33 mm; respectively) and in StUB (2.36, 2.28 and 2.14 mm; respectively, all P < 0.001).

CONCLUSIONS: Although bipolar biparietal bidirectional RF ablation results in smaller lesions than uniparietal bipolar and unipolar ablation, their capacity to penetrate the tissue is much higher. Moreover, in uniparietal RF applications, the energy spreads in the superficial layers of the tissue but fails to penetrate. Therefore, the degree of transmurality is much higher when using such a 'truly bipolar' ablation approach.

Original languageEnglish
Pages (from-to)34-42
Number of pages9
JournalInteractive Cardiovascular and Thoracic Surgery
Volume33
Issue number1
DOIs
Publication statusPublished - Jul 2021

Keywords

  • Hybrid AF ablation
  • Bipolar ablation
  • In vitro simulation
  • Catheter ablation
  • Image processing
  • ATRIAL-FIBRILLATION
  • BEATING HEART
  • CATHETER ABLATION
  • PULMONARY VEINS
  • ENERGY
  • PERFORMANCE
  • MONOPOLAR
  • SAFETY

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