Relationship between catheter forces, lesion characteristics, "popping," and char formation: Experience with robotic navigation system

Luigi Di Biase, Andrea Natale, Conor Barrett, Carmela Tan, Claude S. Elayi, Chi Keong Ching, Paul Wang, Amin Al-Ahmad, Mauricio Arruda, J. David Burkhardt, Brian J. Wisnoskey, Punam Chowdhury, Shari De Marco, Luciana Armaganijan, Kenneth N. Litwak, Robert A. Schweikert, Jennifer E. Cummings

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Force Sensors and Catheter Ablation. Introduction: Popping, char and perforation are complications that can occur following catheter ablation. We measured the amount of grams (g) applied to the endocardium during ablation using a sensor incorporated in the long sheath of a robotic system. We evaluated the relationship between lesion formation, pressure, and the development of complications. Methods: Using a robotic navigation system, lesions were placed in the left atrium (LA) at six settings, using a constant duration (40 seconds) and flow rate of either 17 cc/min or 30 cc/min with an open irrigated catheter (OIC). Evidence of complications was noted and lesion location recorded for later analysis at necropsy. Results: Lesions using 30 Watts (W) were more likely to be transmural at higher (>40 g) than lower (<30 g) pressures (75% vs 25%, P < 0.001). Significantly higher number of lesions using >40 g of pressure demonstrated "popping" and crater formation as compared with lesions with 20-30 g of pressure (41% vs 15%, P = 0.008). A majority of lesions placed using higher power (45 W) with higher pressures (>40 g) were associated with char and crater formation (66.7%). No lesions using 10 g of pressure were transmural, regardless of the power. Lesions placed with a power setting less than 35 W were more likely to result in "relative" sparing of the endocardial surface than lesions at a power setting higher than 35 W (62% vs 33.3%, P = 0.02) regardless of the pressure. Conclusions: When using an OIC, lower power settings (≤35 W) and lower/medium contact pressure were more likely to show a "relative" spared endocardial surface. Overall, contact pressure between 20 g and 30 g and a power setting of 40 W appeared to achieve transmurality by preserving safety.

Original languageEnglish (US)
Pages (from-to)436-440
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

Fingerprint

Trout
Robotics
Catheters
Pressure
Catheter Ablation
Endocardium
Heart Atria
Safety

Keywords

  • Catheter ablation
  • Char
  • Complications
  • Force sensors
  • Left atrium
  • Perforations
  • Popping
  • Remote robotic navigation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Relationship between catheter forces, lesion characteristics, "popping," and char formation : Experience with robotic navigation system. / Di Biase, Luigi; Natale, Andrea; Barrett, Conor; Tan, Carmela; Elayi, Claude S.; Ching, Chi Keong; Wang, Paul; Al-Ahmad, Amin; Arruda, Mauricio; Burkhardt, J. David; Wisnoskey, Brian J.; Chowdhury, Punam; De Marco, Shari; Armaganijan, Luciana; Litwak, Kenneth N.; Schweikert, Robert A.; Cummings, Jennifer E.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 4, 04.2009, p. 436-440.

Research output: Contribution to journalArticle

Di Biase, L, Natale, A, Barrett, C, Tan, C, Elayi, CS, Ching, CK, Wang, P, Al-Ahmad, A, Arruda, M, Burkhardt, JD, Wisnoskey, BJ, Chowdhury, P, De Marco, S, Armaganijan, L, Litwak, KN, Schweikert, RA & Cummings, JE 2009, 'Relationship between catheter forces, lesion characteristics, "popping," and char formation: Experience with robotic navigation system', Journal of Cardiovascular Electrophysiology, vol. 20, no. 4, pp. 436-440. https://doi.org/10.1111/j.1540-8167.2008.01355.x
Di Biase, Luigi ; Natale, Andrea ; Barrett, Conor ; Tan, Carmela ; Elayi, Claude S. ; Ching, Chi Keong ; Wang, Paul ; Al-Ahmad, Amin ; Arruda, Mauricio ; Burkhardt, J. David ; Wisnoskey, Brian J. ; Chowdhury, Punam ; De Marco, Shari ; Armaganijan, Luciana ; Litwak, Kenneth N. ; Schweikert, Robert A. ; Cummings, Jennifer E. / Relationship between catheter forces, lesion characteristics, "popping," and char formation : Experience with robotic navigation system. In: Journal of Cardiovascular Electrophysiology. 2009 ; Vol. 20, No. 4. pp. 436-440.
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abstract = "Force Sensors and Catheter Ablation. Introduction: Popping, char and perforation are complications that can occur following catheter ablation. We measured the amount of grams (g) applied to the endocardium during ablation using a sensor incorporated in the long sheath of a robotic system. We evaluated the relationship between lesion formation, pressure, and the development of complications. Methods: Using a robotic navigation system, lesions were placed in the left atrium (LA) at six settings, using a constant duration (40 seconds) and flow rate of either 17 cc/min or 30 cc/min with an open irrigated catheter (OIC). Evidence of complications was noted and lesion location recorded for later analysis at necropsy. Results: Lesions using 30 Watts (W) were more likely to be transmural at higher (>40 g) than lower (<30 g) pressures (75{\%} vs 25{\%}, P < 0.001). Significantly higher number of lesions using >40 g of pressure demonstrated {"}popping{"} and crater formation as compared with lesions with 20-30 g of pressure (41{\%} vs 15{\%}, P = 0.008). A majority of lesions placed using higher power (45 W) with higher pressures (>40 g) were associated with char and crater formation (66.7{\%}). No lesions using 10 g of pressure were transmural, regardless of the power. Lesions placed with a power setting less than 35 W were more likely to result in {"}relative{"} sparing of the endocardial surface than lesions at a power setting higher than 35 W (62{\%} vs 33.3{\%}, P = 0.02) regardless of the pressure. Conclusions: When using an OIC, lower power settings (≤35 W) and lower/medium contact pressure were more likely to show a {"}relative{"} spared endocardial surface. Overall, contact pressure between 20 g and 30 g and a power setting of 40 W appeared to achieve transmurality by preserving safety.",
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AU - Di Biase, Luigi

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AU - Barrett, Conor

AU - Tan, Carmela

AU - Elayi, Claude S.

AU - Ching, Chi Keong

AU - Wang, Paul

AU - Al-Ahmad, Amin

AU - Arruda, Mauricio

AU - Burkhardt, J. David

AU - Wisnoskey, Brian J.

AU - Chowdhury, Punam

AU - De Marco, Shari

AU - Armaganijan, Luciana

AU - Litwak, Kenneth N.

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N2 - Force Sensors and Catheter Ablation. Introduction: Popping, char and perforation are complications that can occur following catheter ablation. We measured the amount of grams (g) applied to the endocardium during ablation using a sensor incorporated in the long sheath of a robotic system. We evaluated the relationship between lesion formation, pressure, and the development of complications. Methods: Using a robotic navigation system, lesions were placed in the left atrium (LA) at six settings, using a constant duration (40 seconds) and flow rate of either 17 cc/min or 30 cc/min with an open irrigated catheter (OIC). Evidence of complications was noted and lesion location recorded for later analysis at necropsy. Results: Lesions using 30 Watts (W) were more likely to be transmural at higher (>40 g) than lower (<30 g) pressures (75% vs 25%, P < 0.001). Significantly higher number of lesions using >40 g of pressure demonstrated "popping" and crater formation as compared with lesions with 20-30 g of pressure (41% vs 15%, P = 0.008). A majority of lesions placed using higher power (45 W) with higher pressures (>40 g) were associated with char and crater formation (66.7%). No lesions using 10 g of pressure were transmural, regardless of the power. Lesions placed with a power setting less than 35 W were more likely to result in "relative" sparing of the endocardial surface than lesions at a power setting higher than 35 W (62% vs 33.3%, P = 0.02) regardless of the pressure. Conclusions: When using an OIC, lower power settings (≤35 W) and lower/medium contact pressure were more likely to show a "relative" spared endocardial surface. Overall, contact pressure between 20 g and 30 g and a power setting of 40 W appeared to achieve transmurality by preserving safety.

AB - Force Sensors and Catheter Ablation. Introduction: Popping, char and perforation are complications that can occur following catheter ablation. We measured the amount of grams (g) applied to the endocardium during ablation using a sensor incorporated in the long sheath of a robotic system. We evaluated the relationship between lesion formation, pressure, and the development of complications. Methods: Using a robotic navigation system, lesions were placed in the left atrium (LA) at six settings, using a constant duration (40 seconds) and flow rate of either 17 cc/min or 30 cc/min with an open irrigated catheter (OIC). Evidence of complications was noted and lesion location recorded for later analysis at necropsy. Results: Lesions using 30 Watts (W) were more likely to be transmural at higher (>40 g) than lower (<30 g) pressures (75% vs 25%, P < 0.001). Significantly higher number of lesions using >40 g of pressure demonstrated "popping" and crater formation as compared with lesions with 20-30 g of pressure (41% vs 15%, P = 0.008). A majority of lesions placed using higher power (45 W) with higher pressures (>40 g) were associated with char and crater formation (66.7%). No lesions using 10 g of pressure were transmural, regardless of the power. Lesions placed with a power setting less than 35 W were more likely to result in "relative" sparing of the endocardial surface than lesions at a power setting higher than 35 W (62% vs 33.3%, P = 0.02) regardless of the pressure. Conclusions: When using an OIC, lower power settings (≤35 W) and lower/medium contact pressure were more likely to show a "relative" spared endocardial surface. Overall, contact pressure between 20 g and 30 g and a power setting of 40 W appeared to achieve transmurality by preserving safety.

KW - Catheter ablation

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KW - Force sensors

KW - Left atrium

KW - Perforations

KW - Popping

KW - Remote robotic navigation

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