Linear lesion radiofrequency ablation in canine vagal atrial fibrillation: Effects of special catheters designed for efficiency, and the critical role of lesions from the crista terminalis to the superior vena cava

John Devens Fisher, Shoshana Kahn, Jennifer Han, Alex Kogan, Michele Nanna

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF). Methods: Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form "longitude and latitude" grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37°C. Results: The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation. Conclusions: Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.

Original languageEnglish (US)
Pages (from-to)241-252
Number of pages12
JournalJournal of Interventional Cardiac Electrophysiology
Volume5
Issue number3
DOIs
StatePublished - 2001

Fingerprint

Superior Vena Cava
Atrial Fibrillation
Canidae
Electrodes
Catheters
Inferior Vena Cava
Atrial Flutter
Tricuspid Valve
Autopsy
Dogs
Hemorrhage

Keywords

  • Atrial fibrillation
  • Basket catheters
  • Canines
  • Coil electrodes
  • Linear lesions
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{95c3f9fcead6484087a0560ad2ef5285,
title = "Linear lesion radiofrequency ablation in canine vagal atrial fibrillation: Effects of special catheters designed for efficiency, and the critical role of lesions from the crista terminalis to the superior vena cava",
abstract = "Objective: To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF). Methods: Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form {"}longitude and latitude{"} grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37°C. Results: The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation. Conclusions: Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.",
keywords = "Atrial fibrillation, Basket catheters, Canines, Coil electrodes, Linear lesions, Radiofrequency ablation",
author = "Fisher, {John Devens} and Shoshana Kahn and Jennifer Han and Alex Kogan and Michele Nanna",
year = "2001",
doi = "10.1023/A:1011456430460",
language = "English (US)",
volume = "5",
pages = "241--252",
journal = "Journal of Interventional Cardiac Electrophysiology",
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TY - JOUR

T1 - Linear lesion radiofrequency ablation in canine vagal atrial fibrillation

T2 - Effects of special catheters designed for efficiency, and the critical role of lesions from the crista terminalis to the superior vena cava

AU - Fisher, John Devens

AU - Kahn, Shoshana

AU - Han, Jennifer

AU - Kogan, Alex

AU - Nanna, Michele

PY - 2001

Y1 - 2001

N2 - Objective: To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF). Methods: Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form "longitude and latitude" grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37°C. Results: The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation. Conclusions: Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.

AB - Objective: To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF). Methods: Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form "longitude and latitude" grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37°C. Results: The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation. Conclusions: Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.

KW - Atrial fibrillation

KW - Basket catheters

KW - Canines

KW - Coil electrodes

KW - Linear lesions

KW - Radiofrequency ablation

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