TY - JOUR
T1 - Contact forces during hybrid atrial fibrillation ablation: an in vitro evaluation
AU - Lozekoot, Pieter W. J.
AU - de Jong, Monique M. J.
AU - Gelsomino, Sandro
AU - Parise, Orlando
AU - Matteucci, Francesco
AU - Luca, Fabiana
AU - Kumar, N.
AU - Nijs, Jan
AU - Czapla, Jens
AU - Kwant, Paul B
AU - Bani, Daniele
AU - Gensini, Gian Franco
AU - Pison, Laurent
AU - Crijns, Harry J. G. M.
AU - Maessen, Jos G.
AU - La Meir, Mark
PY - 2016/3
Y1 - 2016/3
N2 - Purpose Data on epicardial contact force efficacy in dual epicardial-endocardial atrial fibrillation ablation procedures are lacking. We present an in vitro study on the importance of epicardial and endocardial contact forces during this procedure. Methods The in vitro setup consists of two separate chambers, mimicking the endocardial and epicardial sides of the heart. A circuit, including a pump and a heat exchanger, circulates porcine blood through the endocardial chamber. A septum, with a cut out, allows the placement of a magnetically fixed tissue holder, securing porcine atrial tissue, in the middle of both chambers. Two trocars provide access to the epicardium and endocardium. Force transducers mounted on both catheter holders allow real-time contact force monitoring, while a railing system allows controlled contact force adjustment. We histologically assessed different combinations of epiendocardial radiofrequency ablation contact forces using porcine atria, evaluating the ablation's diameters, area, and volume. Results An epicardial ablation with forces of 100 or 300 g, followed by an endocardial ablation with a force of 20 g did not achieve transmurality. Increasing endocardial forces to 30 and 40 g combined with an epicardial force ranging from 100 to 300 and 500 g led to transmurality with significant increases in lesion's diameters, area, and volumes. Conclusions Increased endocardial contact forces led to larger ablation lesions regardless of standard epicardial pressure forces. In order to gain transmurality in a model of a combined epicardial-endocardial procedure, a minimal endocardial force of 30 g combined with an epicardial force of 100 g is necessary.
AB - Purpose Data on epicardial contact force efficacy in dual epicardial-endocardial atrial fibrillation ablation procedures are lacking. We present an in vitro study on the importance of epicardial and endocardial contact forces during this procedure. Methods The in vitro setup consists of two separate chambers, mimicking the endocardial and epicardial sides of the heart. A circuit, including a pump and a heat exchanger, circulates porcine blood through the endocardial chamber. A septum, with a cut out, allows the placement of a magnetically fixed tissue holder, securing porcine atrial tissue, in the middle of both chambers. Two trocars provide access to the epicardium and endocardium. Force transducers mounted on both catheter holders allow real-time contact force monitoring, while a railing system allows controlled contact force adjustment. We histologically assessed different combinations of epiendocardial radiofrequency ablation contact forces using porcine atria, evaluating the ablation's diameters, area, and volume. Results An epicardial ablation with forces of 100 or 300 g, followed by an endocardial ablation with a force of 20 g did not achieve transmurality. Increasing endocardial forces to 30 and 40 g combined with an epicardial force ranging from 100 to 300 and 500 g led to transmurality with significant increases in lesion's diameters, area, and volumes. Conclusions Increased endocardial contact forces led to larger ablation lesions regardless of standard epicardial pressure forces. In order to gain transmurality in a model of a combined epicardial-endocardial procedure, a minimal endocardial force of 30 g combined with an epicardial force of 100 g is necessary.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Atrial arrhythmias
KW - Computer model simulation
KW - Contact force
U2 - 10.1007/s10840-015-0089-y
DO - 10.1007/s10840-015-0089-y
M3 - Article
C2 - 26728030
SN - 1383-875X
VL - 45
SP - 189
EP - 197
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -