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Heart Rhythm. 2015 Aug;12(8):1827-35. doi: 10.1016/j.hrthm.2015.04.012. Epub 2015 Apr 8.

Real-time atrial wall imaging during radiofrequency ablation in a porcine model.

Author information

1
Cardiology Department, Nimes University Hospital, Nimes, France. Electronic address: mathieu.granier@chu-nimes.fr.
2
Cardiology Department, Nimes University Hospital, Nimes, France.
3
Pathology Department, Montpellier University Hospital, Montpellier, France.
4
EA 2992: Dysfunction of Vascular Interfaces, Faculty of Medicine, Montpellier University, Nimes, France.
5
Cardiology Department, Nimes University Hospital, Nimes, France; Montpellier University, Nimes, France.
6
Cardiology Department, Montpellier University Hospital; INSERM U1046 Montpellier University, Montpellier,France.
7
Cardiology Department, Nimes University Hospital, Nimes, France; EA 2992: Dysfunction of Vascular Interfaces, Faculty of Medicine, Montpellier University, Nimes, France.

Abstract

BACKGROUND:

Real-time monitoring of radiofrequency (RF) ablation remains challenging.

OBJECTIVE:

We used intravascular ultrasound (IVUS) to describe atrial wall changes during RF ablation and to assess the extent of RF-induced lesions.

METHODS:

In 9 piglets, RF and IVUS catheters were coupled and introduced into the right atrium. RF applications were performed along the intercaval line. Corresponding IVUS images were analyzed. Wall thickness was correlated with electrogram (EGM) changes (n = 9) and histology (n = 5).

RESULTS:

There were 66 RF applications performed in 57 sites. IVUS provided real-time imaging of the atrial wall during RF application in all but 2 sites. IVUS demonstrated significant (>20%) and immediate increase in atrial wall thickness in 71.4% of RF applications. It showed epicardial or intramyocardial effusion in 30% of cases, 2 steam pops, 1 intramural hematoma, and 1 thrombus. EGM amplitude decreased and thickness increased after RF application than at baseline (2.20 ± 1.11 to 0.99 ± 0.62 mV and 1.34 ± 0.53 to 1.93 ± 0.80 mm, respectively; P < .001 for each). However, EGM and thickness changes were poorly correlated (r = 0.43; P < .05). Histologically and echographically measured thicknesses were correlated (r = 0.71; P = .004), but echographic thickness change was not related to histological lesion transmurality.

CONCLUSION:

An IVUS probe coupled to an RF catheter can provide relevant real-time imaging of the atrial wall during ablation. Although thickness change does not appear as a good predictor of the transmural extent, direct visualization and monitoring of RF application may provide new information to guide and secure RF ablation.

KEYWORDS:

Atrial fibrillation; IVUS imaging of atrial wall; RF ablation; RF lesion extent; Radiofrequency ablation; Radiofrequency ablation in a porcine model; Transmural extent of RF lesions; Transmural lesion extent

Comment in

PMID:
25863159
DOI:
10.1016/j.hrthm.2015.04.012
[Indexed for MEDLINE]

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