Radiofrequency and Cryo-Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study

Yousef H. Darrat, Anuj Agarwal, Gustavo X. Morales, Joseph Thompson, Ahmed Abdel-Latif, Kelly Waespe, Luigi Di Biase, Andrea Natale, Abhijit Patwardan, Claude Samy Elayi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Intorduction: Medical societies and cardiac implantable electronic device (CIED) manufacturers recommend avoiding close or direct contact between the body of transvenous leads and ablation catheters used to treat cardiac arrhythmias. These recommendations are made despite the lack of clinical studies. However, the target myocardium for successful ablation can be contiguous to CIED leads. Methods and Results: We examine in vitro the effects of direct application of radiofrequency (RF) and cryo-ablation energy on the integrity and functionality of CIED leads (excluding the pacing electrodes and defibrillation coils). A saline bath was created to mimic the body milieu. CIED leads, including all commercially available lead insulation materials, were connected to a CIED pulse generator and placed in direct contact with an ablation catheter in the tissue bath. RF and cryo-ablation energy were delivered under various conditions, including maximal ablation power, temperature, and impedance via the RF generator. CIED lead functionality, reflective of conductor integrity, was evaluated through lead impedance monitoring during ablation. CIED leads were then visually inspected, and examined with optic and electron microscopy as per protocol. A total of 42 leads were studied. All leads showed the absence of insulation damage at the site of ablation visually and with microscopy. Lead functionality was also preserved in all leads. Conclusion: Catheter ablation in contact with CIED leads using radiofrequency or cryo-ablation in vitro did not affect lead body integrity and function despite aggressive ablation settings. It may be reasonable to perform ablation in contact with the body of CIED leads when clinically necessary.

Original languageEnglish (US)
Pages (from-to)976-980
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume27
Issue number8
DOIs
StatePublished - 2016
Externally publishedYes

Fingerprint

Equipment and Supplies
Catheter Ablation
Electric Impedance
Baths
Lead
In Vitro Techniques
Medical Societies
Cardiac Arrhythmias
Microscopy
Myocardium
Electron Microscopy
Electrodes
Temperature

Keywords

  • cardiac implantable electronic device leads
  • catheter ablation
  • cryo-ablation
  • implantable cardioverter defibrillator
  • pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Darrat, Y. H., Agarwal, A., Morales, G. X., Thompson, J., Abdel-Latif, A., Waespe, K., ... Elayi, C. S. (2016). Radiofrequency and Cryo-Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study. Journal of Cardiovascular Electrophysiology, 27(8), 976-980. https://doi.org/10.1111/jce.13007

Radiofrequency and Cryo-Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity : An In Vitro Study. / Darrat, Yousef H.; Agarwal, Anuj; Morales, Gustavo X.; Thompson, Joseph; Abdel-Latif, Ahmed; Waespe, Kelly; Di Biase, Luigi; Natale, Andrea; Patwardan, Abhijit; Elayi, Claude Samy.

In: Journal of Cardiovascular Electrophysiology, Vol. 27, No. 8, 2016, p. 976-980.

Research output: Contribution to journalArticle

Darrat, YH, Agarwal, A, Morales, GX, Thompson, J, Abdel-Latif, A, Waespe, K, Di Biase, L, Natale, A, Patwardan, A & Elayi, CS 2016, 'Radiofrequency and Cryo-Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study', Journal of Cardiovascular Electrophysiology, vol. 27, no. 8, pp. 976-980. https://doi.org/10.1111/jce.13007
Darrat, Yousef H. ; Agarwal, Anuj ; Morales, Gustavo X. ; Thompson, Joseph ; Abdel-Latif, Ahmed ; Waespe, Kelly ; Di Biase, Luigi ; Natale, Andrea ; Patwardan, Abhijit ; Elayi, Claude Samy. / Radiofrequency and Cryo-Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity : An In Vitro Study. In: Journal of Cardiovascular Electrophysiology. 2016 ; Vol. 27, No. 8. pp. 976-980.
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AU - Agarwal, Anuj

AU - Morales, Gustavo X.

AU - Thompson, Joseph

AU - Abdel-Latif, Ahmed

AU - Waespe, Kelly

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Patwardan, Abhijit

AU - Elayi, Claude Samy

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N2 - Intorduction: Medical societies and cardiac implantable electronic device (CIED) manufacturers recommend avoiding close or direct contact between the body of transvenous leads and ablation catheters used to treat cardiac arrhythmias. These recommendations are made despite the lack of clinical studies. However, the target myocardium for successful ablation can be contiguous to CIED leads. Methods and Results: We examine in vitro the effects of direct application of radiofrequency (RF) and cryo-ablation energy on the integrity and functionality of CIED leads (excluding the pacing electrodes and defibrillation coils). A saline bath was created to mimic the body milieu. CIED leads, including all commercially available lead insulation materials, were connected to a CIED pulse generator and placed in direct contact with an ablation catheter in the tissue bath. RF and cryo-ablation energy were delivered under various conditions, including maximal ablation power, temperature, and impedance via the RF generator. CIED lead functionality, reflective of conductor integrity, was evaluated through lead impedance monitoring during ablation. CIED leads were then visually inspected, and examined with optic and electron microscopy as per protocol. A total of 42 leads were studied. All leads showed the absence of insulation damage at the site of ablation visually and with microscopy. Lead functionality was also preserved in all leads. Conclusion: Catheter ablation in contact with CIED leads using radiofrequency or cryo-ablation in vitro did not affect lead body integrity and function despite aggressive ablation settings. It may be reasonable to perform ablation in contact with the body of CIED leads when clinically necessary.

AB - Intorduction: Medical societies and cardiac implantable electronic device (CIED) manufacturers recommend avoiding close or direct contact between the body of transvenous leads and ablation catheters used to treat cardiac arrhythmias. These recommendations are made despite the lack of clinical studies. However, the target myocardium for successful ablation can be contiguous to CIED leads. Methods and Results: We examine in vitro the effects of direct application of radiofrequency (RF) and cryo-ablation energy on the integrity and functionality of CIED leads (excluding the pacing electrodes and defibrillation coils). A saline bath was created to mimic the body milieu. CIED leads, including all commercially available lead insulation materials, were connected to a CIED pulse generator and placed in direct contact with an ablation catheter in the tissue bath. RF and cryo-ablation energy were delivered under various conditions, including maximal ablation power, temperature, and impedance via the RF generator. CIED lead functionality, reflective of conductor integrity, was evaluated through lead impedance monitoring during ablation. CIED leads were then visually inspected, and examined with optic and electron microscopy as per protocol. A total of 42 leads were studied. All leads showed the absence of insulation damage at the site of ablation visually and with microscopy. Lead functionality was also preserved in all leads. Conclusion: Catheter ablation in contact with CIED leads using radiofrequency or cryo-ablation in vitro did not affect lead body integrity and function despite aggressive ablation settings. It may be reasonable to perform ablation in contact with the body of CIED leads when clinically necessary.

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