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Journal of Interventional Cardiac Electrophysiology

Published in:

01-06-2012

Efficacy of pulmonary vein isolation with a novel hot balloon ablation catheter

Authors: Rudolph F. Evonich, David M. Nori, David E. Haines

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2012

Abstract

Background

Due to the variable anatomy of the human pulmonary vein (PV), PV isolation for atrial fibrillation ablation is challenging. A novel hot balloon ablation catheter has been developed to improve ablation outcomes. The efficacy, histopathologic lesion characteristics, and thermodynamics of this technology were examined.

Methods

Swine underwent left atrial (n = 24) and superior vena cava (SVC, n = 7) catheterization with a compliant balloon catheter filled with saline and contrast. After PV mapping and angiography, ablation was performed with radiofrequency energy heating of the balloon contents. Central balloon temperatures were varied from 60°C to 90°C, and durations of energy delivery were varied from 60 to 300 s. Endocardial and epicardial temperatures were recorded contiguous to the balloon during SVC ablations. Pathology was examined.

Results

With a mean of 1.4 ± 0.9 ablations per PV at 70°C, 93% were electrically isolated. Necropsy exam revealed extraostial lesions without charring. PVs ablated at temperatures ≥80°C and durations ≥180 s were associated with a high rate of successful isolation with a single ablation. Higher-temperature lesions displayed greater histopathologic uniformity, but more marked fibrin deposition. Chronic lesions revealed granulation tissue and fibrosis. No thromboembolic events were observed and histopathology of the phrenic nerve and esophagus was normal in all specimens.

Conclusions

The hot balloon ablation catheter appears to be a safe and effective tool for PV isolation. Higher temperatures and longer ablation durations are associated with a higher single ablation success rate.

Wazni, O., Marrouche, N., Martin, D., Verma, A., Bhargava, M., Saliba, W., Bash, D., Schweikert, R., Brachmann, J., Gunther, J., Gutleben, K., Pisano, E., Potenza, D., Fanelli, R., Raviele, A., Themistoclakis, S., Rossillo, A., Bonso, A., & Natale, A. (2005). Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: A randomized trial. Journal of the American Medical Association, 293, 2634–2640.PubMedCrossRef

Oral, H., Pappone, C., Chugh, A., Good, E., Bogun, F., Pelosi, F., Bates, E., Lehmann, M., Vicedomini, G., Augello, G., Agricola, E., Sala, S., Santinelli, V., & Morady, F. (2006). Circumferential pulmonary-vein ablation for chronic atrial fibrillation. The New England Journal of Medicine, 354, 934–941.PubMedCrossRef

Pappone, C., Rosanio, S., Augello, G., Gallus, G., Vicedomini, G., Mazzone, P., Gulletta, S., Gugliotta, F., Pappone, A., Santinelli, V., Tortoriello, V., Sala, S., Zangrillo, A., Crescenzi, G., Benussi, S., & Alfieri, O. (2003). Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: Outcomes from a controlled nonrandomized long-term study. Journal of the American College of Cardiology, 42, 185–197.PubMedCrossRef

Engelmann, M., & Pehrson, S. (2003). Quality of life in nonpharmacologic treatment of atrial fibrillation. Euro Heart Journal, 24, 1387–1400.CrossRef

Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S. A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., Haines, D. E., Haissaguerre, M., Iesaka, Y., Jackman, W., Jais, P., Kottkamp, H., Kuck, K. H., Lindsay, B. D., Marchlinski, F. E., McCarthy, P. M., Mont, J. L., Morady, F., Nademanee, K., Natale, A., Pappone, C., Prystowsky, E., Raviele, A., Ruskin, J. N., & Shemin, R. J. (2007). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for personnel, policy, procedures and follow-up. Hear Rhythm, 4, 816–861.CrossRef

O’Neill, M. D., Jais, P., Hocini, M., Sacher, F., Klein, G. J., Clementy, J., & Haissaguerre, M. (2007). Catheter ablation for atrial fibrillation. Circulation, 116, 1515–1523.PubMedCrossRef

Verma, A., Kilicaslan, F., Pisano, E., Marrouche, N. F., Fanelli, R., Brachmann, J., Geunther, J., Potenza, D., Martin, D. O., Cummings, J., Burkhardt, J. D., Saliba, W., Schweikert, R. A., & Natale, A. (2005). Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation, 112, 627–635.PubMedCrossRef

Haissaguerre, M., Jais, P., Shah, D. C., Garrigue, S., Takahashi, A., Lavergne, T., Hocini, M., Peng, J. T., Roudaut, R., & Clementy, J. (2000). Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation, 101, 1409–1417.PubMed

Ouyang, F., Bansch, D., Ernst, S., Schaumann, A., Hachiya, H., Chen, M., Chun, J., Falk, P., Khanedani, A., Antz, M., & Kuck, K. H. (2004). Complete isolation of left atrium surrounding the pulmonary veins: New insights from the double-lasso technique in paroxysmal atrial fibrillation. Circulation, 110, 2090–2096.PubMedCrossRef

10.

Nademanee, K., & Gidney, B. A. (2010). Pulmonary vein isolation without reconnection: A decade of trying. Journal of Cardiovascular Electrophysiology, 21, 738–740.PubMed

11.

Cappato, R., Negroni, S., Pecora, D., Bentivegna, S., Lupo, P. P., Carolei, A., Esposito, C., Furlanello, F., & De Ambroggi, L. (2003). Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation, 108, 1599–1604.PubMedCrossRef

12.

Sauer, W. H., McKernan, M. L., Lin, D., Gerstenfeld, E. P., Callans, D. J., & Marchlinski, F. E. (2006). Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Hear Rhythm, 3, 1024–1028.CrossRef

13.

Schmidt, B., Antz, M., Ernst, S., Ouyang, F., Falk, P., Chun, J. K., & Kuck, K. H. (2007). Pulmonary vein isolation by high-intensity focused ultrasound: First-in-man study with a steerable balloon catheter. Hear Rhythm, 4, 575–584.CrossRef

14.

Dukkipati, S. R., Neuzil, P., Skoda, J., Petru, J., d’ Avila, A., Doshi, S. K., & Reddy, V. Y. (2010). Visual balloon-guided point-by-point ablation: Reliable, reproducible, and persistent pulmonary vein isolation. Circulation. Arrhythmia and Electrophysiology, 3, 266–273.PubMedCrossRef

15.

Kühne, M., Suter, Y., Altmann, D., Ammann, P., Schaer, B., Osswald, S., & Sticherling, C. (2010). Cryoballoon versus radiofrequency catheter ablation of paroxysmal atrial fibrillation: Biomarkers of myocardial injury, recurrence rates, and pulmonary vein reconnection patterns. Hear Rhythm, 7, 1770–1776.CrossRef

16.

Tanaka, K., Satake, S., Saito, S., Takahashi, S., Hiroe, Y., Miyashita, Y., Tanaka, S., Tanaka, M., & Watanabe, Y. (2001). A new radiofrequency thermal balloon catheter for pulmonary vein isolation. Journal of the American College of Cardiology, 38, 2079–2086.PubMedCrossRef

17.

Satake, S., Tanaka, K., Saito, S., Tanaka, S., Sohara, H., Hiroe, Y., Miyashita, Y., Takahashi, S., Murakami, M., & Watanabe, Y. (2003). Usefulness of a new radiofrequency thermal balloon catheter for pulmonary vein isolation: A new device for treatment of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 14, 609–615.PubMedCrossRef

18.

Sohara, H., Takeda, H., Ueno, H., Oda, T., & Satake, S. (2009). Feasibility of the radiofrequency hot balloon catheter for isolation of the posterior left atrium and pulmonary veins for the treatment of atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 2, 225–232.PubMedCrossRef

19.

Haines, D. E., Watson, D. D., & Verow, A. F. (1990). Electrode radius predicts lesion radius during radiofrequency energy heating. Validation of a proposed thermodynamic model. Circulation Research, 67, 124–129.PubMed

20.

Cabrera, J. A., Ho, S. Y., Climent, V., Fuertes, B., Murillo, M., & Sánchez-Quintana, D. (2009). Morphological evidence of muscular connections between contiguous pulmonary venous orifices: Relevance of the interpulmonary isthmus for catheter ablation in atrial fibrillation. Hear Rhythm, 6, 1192–1198.CrossRef

21.

Manolis, A. S., Melita-Manolis, H., Vassilikos, V., Maounis, T., Chiladakis, J., Christopoulou-Cokkinou, V., & Cokkinos, D. V. (1996). Thrombogenicity of radiofrequency lesions: Results with serial D-dimer determinations. Journal of the American College of Cardiology, 28, 1257–1261.PubMedCrossRef

22.

Khairy, P., Chauvet, P., Lehmann, J., Lambert, J., Macle, L., Tanguay, J. F., Sirois, M. G., Santoianni, D., & Dubuc, M. (2003). Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation, 107, 2045–2050.PubMedCrossRef

23.

Neven, K., Schmidt, B., Metzner, A., Otomo, K., Nuyens, D., De Potter, T., Chun, K. R., Ouyang, F., & Kuck, K. H. (2010). Fatal end of a safety algorithm for pulmonary vein isolation with use of high-intensity focused ultrasound. Circulation. Arrhythmia and Electrophysiology, 3, 260–265.PubMedCrossRef

24.

Nakagawa, H., Yamanashi, W. S., Pitha, J. V., Arruda, M., Wang, X., Ohtomo, K., Beckman, K. J., McClelland, J. H., Lazzara, R., & Jackman, W. M. (1995). Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation. Circulation, 91, 2264–2273.PubMed

Title: Efficacy of pulmonary vein isolation with a novel hot balloon ablation catheter
Authors: Rudolph F. Evonich
David M. Nori
David E. Haines
Publication date: 01-06-2012
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2012
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-011-9646-1

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Efficacy of pulmonary vein isolation with a novel hot balloon ablation catheter

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