Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue

Preliminary Observations From Experimental and Clinical Studies

Saurabh Kumar, Jorge E. Romero, William G. Stevenson, Lori Foley, Ryan Caulfield, Akira Fujii, Shinichi Tanigawa, Laurence M. Epstein, Bruce A. Koplan, Usha B. Tedrow, Roy M. John, Gregory F. Michaud

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. Background Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. Methods Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation. Results Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter at the epicardial surface. In humans, impedance, pace capture, and transmurality data also strongly favored low-flow lesions. There was no difference in acute pulmonary vein isolation, complications, or 12-month arrhythmia-free survival between the groups. Conclusions Low-flow irrigated ablation provides favorable lesion characteristics for posterior LA ablation without increasing the risk of adverse events.

Original languageEnglish (US)
Pages (from-to)1114-1125
Number of pages12
JournalJACC: Clinical Electrophysiology
Volume3
Issue number10
DOIs
StatePublished - Oct 1 2017

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Heart Atria
Swine
Electric Impedance
Pulmonary Veins
Cardiac Arrhythmias
Clinical Studies
Safety
Temperature
Survival
Incidence
Wounds and Injuries

Keywords

  • atrial fibrillation
  • impedance
  • irrigated catheter ablation
  • transmural lesions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue : Preliminary Observations From Experimental and Clinical Studies. / Kumar, Saurabh; Romero, Jorge E.; Stevenson, William G.; Foley, Lori; Caulfield, Ryan; Fujii, Akira; Tanigawa, Shinichi; Epstein, Laurence M.; Koplan, Bruce A.; Tedrow, Usha B.; John, Roy M.; Michaud, Gregory F.

In: JACC: Clinical Electrophysiology, Vol. 3, No. 10, 01.10.2017, p. 1114-1125.

Research output: Contribution to journalArticle

Kumar, S, Romero, JE, Stevenson, WG, Foley, L, Caulfield, R, Fujii, A, Tanigawa, S, Epstein, LM, Koplan, BA, Tedrow, UB, John, RM & Michaud, GF 2017, 'Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue: Preliminary Observations From Experimental and Clinical Studies', JACC: Clinical Electrophysiology, vol. 3, no. 10, pp. 1114-1125. https://doi.org/10.1016/j.jacep.2017.09.001
Kumar, Saurabh ; Romero, Jorge E. ; Stevenson, William G. ; Foley, Lori ; Caulfield, Ryan ; Fujii, Akira ; Tanigawa, Shinichi ; Epstein, Laurence M. ; Koplan, Bruce A. ; Tedrow, Usha B. ; John, Roy M. ; Michaud, Gregory F. / Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue : Preliminary Observations From Experimental and Clinical Studies. In: JACC: Clinical Electrophysiology. 2017 ; Vol. 3, No. 10. pp. 1114-1125.
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abstract = "Objectives The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. Background Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. Methods Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation. Results Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter at the epicardial surface. In humans, impedance, pace capture, and transmurality data also strongly favored low-flow lesions. There was no difference in acute pulmonary vein isolation, complications, or 12-month arrhythmia-free survival between the groups. Conclusions Low-flow irrigated ablation provides favorable lesion characteristics for posterior LA ablation without increasing the risk of adverse events.",
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T1 - Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue

T2 - Preliminary Observations From Experimental and Clinical Studies

AU - Kumar, Saurabh

AU - Romero, Jorge E.

AU - Stevenson, William G.

AU - Foley, Lori

AU - Caulfield, Ryan

AU - Fujii, Akira

AU - Tanigawa, Shinichi

AU - Epstein, Laurence M.

AU - Koplan, Bruce A.

AU - Tedrow, Usha B.

AU - John, Roy M.

AU - Michaud, Gregory F.

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Y1 - 2017/10/1

N2 - Objectives The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. Background Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. Methods Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation. Results Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter at the epicardial surface. In humans, impedance, pace capture, and transmurality data also strongly favored low-flow lesions. There was no difference in acute pulmonary vein isolation, complications, or 12-month arrhythmia-free survival between the groups. Conclusions Low-flow irrigated ablation provides favorable lesion characteristics for posterior LA ablation without increasing the risk of adverse events.

AB - Objectives The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. Background Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. Methods Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation. Results Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter at the epicardial surface. In humans, impedance, pace capture, and transmurality data also strongly favored low-flow lesions. There was no difference in acute pulmonary vein isolation, complications, or 12-month arrhythmia-free survival between the groups. Conclusions Low-flow irrigated ablation provides favorable lesion characteristics for posterior LA ablation without increasing the risk of adverse events.

KW - atrial fibrillation

KW - impedance

KW - irrigated catheter ablation

KW - transmural lesions

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