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

113 Scopus citations

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 1 2009

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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

Di Biase, L., Natale, A., Barrett, C., Tan, C., Elayi, C. S., Ching, C. K., Wang, P., Al-Ahmad, A., Arruda, M., Burkhardt, J. D., Wisnoskey, B. J., Chowdhury, P., De Marco, S., Armaganijan, L., Litwak, K. N., Schweikert, R. A., & Cummings, J. E. (2009). Relationship between catheter forces, lesion characteristics, "popping," and char formation: Experience with robotic navigation system. Journal of cardiovascular electrophysiology, 20(4), 436-440. https://doi.org/10.1111/j.1540-8167.2008.01355.x