Publication: Evaluación experimental de la eficacia lesiva y seguridad de diferentes catéteres irrigados de ablación
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2015-02-10
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Universidad Complutense de Madrid
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Abstract
"Introducción". La nueva generación de catéteres de ablación irrigados tiene como objetivo mejorar la eficiencia de dicha irrigación. Sin embargo, puede cambiar los patrones de la lesión producida, constituyendo un reto para el operador. Nuestro objetivo fue evaluar experimentalmente 4 catéteres de irrigación abierta mediante la comparación del tamaño de lesión, la seguridad y la transferencia de calor. "Métodos y resultados". Se empleó el modelo de lesión en muslo en 6 cerdos para evaluar la morfología de las lesiones verticales y paralelas (n = 140), creadas por los catéteres ThermoCool®SF, Coolflex™, Blazer Open Irrigated™ y ThermoCool® estándar, a potencia de 30W (60s). Para evaluar la tendencia al sobrecalentamiento del tejido, se realizaron 120 aplicaciones a 50W (180s) que compararon la tasa de pops. La evaluación térmica del proceso de lesión (20W, 60s, n=32) se realizó mediante cámara de infrarrojos en tejido ventricular bovino. A 30W, los nuevos catéteres mostraron temperaturas más bajas en comparación con el catéter ThermoCool®. No se encontraron diferencias importantes de eficacia o seguridad en las aplicaciones paralelas. Sin embargo, en aplicaciones perpendiculares: 1) ThermoCool®SF a 17 ml/min conservó mejor las capas superficiales y centró su efecto térmico máximo más profundo, pero a tasas de flujo recomendadas (8 ml / min) generó las mayores lesiones superficiales; 2) Coolflex ™ creó lesiones menores que SF e indujo fácilmente pops a 50W sin control de temperatura; 3) no se encontraron diferencias importantes comparando Blazer Open Irrigated™ y ThermoCool ®." Conclusiones". Nuestros datos sugieren que durante la ablación con parámetros convencionales, los nuevos catéteres pueden suministrar mayor cantidad de energía. El conocimiento de su diferente comportamiento puede permitir una selección del catéter según el sustrato.
"Background"-New generation open-irrigated catheters aim to improve irrigation efficiency. However, this may change lesion patterns, challenging operators. We aimed to experimentally assess 4 open-irrigated catheters, comparing lesion size, safety and heat transfer. "Methods and Results"-The thigh lesion model was employed in 6 anesthetized pigs to assess the morphology of vertical and parallel lesions (n=140) created by the newer catheters ThermoCool® SF, CoolFlex™ and Blazer™ Open-Irrigated, and the standard ThermoCool®, at a constant power of 30W (60s). To evaluate the propensity for deep-tissue overheating, a set of 120 applications were performed at 50W (180s) comparing steam pop rates. Thermal assessment of the lesion process (20W, 60s, n=32) was performed with an infra-red camera on bovine ventricular tissue. At 30W, the newer catheters showed lower temperature readings compared with the ThermoCool® catheter. No major efficacy or safety differences were found at parallel applications; however, at perpendicular applications: 1) the SF at 17 mL/min better preserved the superficial layers and focused its maximum thermal effect deeper, but at recommended flow rates (8 mL/min) it generated the largest superficial lesions; 2) CoolFlex™ created smaller lesions than SF and readily induced steam pops at 50W without temperature control; 3) no major differences were found comparing Blazer™ Open-Irrigated and ThermoCool®. "Conclusions"-Our data suggest that during ablation at conventional settings, newer catheters may deliver a higher amount of energy as they are less prone to reach temperature cut-off points. Acknowledging their different performances may allow for an informed selection of catheter and irrigation according to the substrate.
"Background"-New generation open-irrigated catheters aim to improve irrigation efficiency. However, this may change lesion patterns, challenging operators. We aimed to experimentally assess 4 open-irrigated catheters, comparing lesion size, safety and heat transfer. "Methods and Results"-The thigh lesion model was employed in 6 anesthetized pigs to assess the morphology of vertical and parallel lesions (n=140) created by the newer catheters ThermoCool® SF, CoolFlex™ and Blazer™ Open-Irrigated, and the standard ThermoCool®, at a constant power of 30W (60s). To evaluate the propensity for deep-tissue overheating, a set of 120 applications were performed at 50W (180s) comparing steam pop rates. Thermal assessment of the lesion process (20W, 60s, n=32) was performed with an infra-red camera on bovine ventricular tissue. At 30W, the newer catheters showed lower temperature readings compared with the ThermoCool® catheter. No major efficacy or safety differences were found at parallel applications; however, at perpendicular applications: 1) the SF at 17 mL/min better preserved the superficial layers and focused its maximum thermal effect deeper, but at recommended flow rates (8 mL/min) it generated the largest superficial lesions; 2) CoolFlex™ created smaller lesions than SF and readily induced steam pops at 50W without temperature control; 3) no major differences were found comparing Blazer™ Open-Irrigated and ThermoCool®. "Conclusions"-Our data suggest that during ablation at conventional settings, newer catheters may deliver a higher amount of energy as they are less prone to reach temperature cut-off points. Acknowledging their different performances may allow for an informed selection of catheter and irrigation according to the substrate.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 29-05-2014