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Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue: Preliminary Observations From Experimental and Clinical Studies.
- Source :
-
JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2017 Oct; Vol. 3 (10), pp. 1114-1125. Date of Electronic Publication: 2017 Oct 16. - Publication Year :
- 2017
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Abstract
- Objectives: The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study.<br />Background: Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible.<br />Methods: Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation.<br />Results: Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter at the epicardial surface. In humans, impedance, pace capture, and transmurality data also strongly favored low-flow lesions. There was no difference in acute pulmonary vein isolation, complications, or 12-month arrhythmia-free survival between the groups.<br />Conclusions: Low-flow irrigated ablation provides favorable lesion characteristics for posterior LA ablation without increasing the risk of adverse events.<br /> (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Animals
Atrial Fibrillation pathology
Atrial Fibrillation physiopathology
Biophysical Phenomena
Catheter Ablation adverse effects
Female
Humans
Male
Middle Aged
Swine
Therapeutic Irrigation adverse effects
Atrial Fibrillation surgery
Catheter Ablation methods
Heart Atria surgery
Therapeutic Irrigation methods
Subjects
Details
- Language :
- English
- ISSN :
- 2405-5018
- Volume :
- 3
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- JACC. Clinical electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 29759494
- Full Text :
- https://doi.org/10.1016/j.jacep.2017.09.001