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Biparietal bidirectional bipolar radiofrequency in hybrid cardiac ablation

Authors :
Mark La Meir
Elham Bidar
Gianmarco Parise
Carlo de Asmundis
Jos G. Maessen
Linda Renata Micali
Bart Maesen
Francesco Matteucci
Sandro Gelsomino
Clinical sciences
Heartrhythmmanagement
Surgical clinical sciences
Cardiac Surgery
CTC
RS: Carim - V04 Surgical intervention
MUMC+: MA Med Staf Spec CTC (9)
RS: Carim - H08 Experimental atrial fibrillation
MUMC+: MA Cardiothoracale Chirurgie (3)
Source :
Interact Cardiovasc Thorac Surg, Interactive Cardiovascular and Thoracic Surgery, 33(1), 34-42. Oxford University Press
Publication Year :
2021
Publisher :
European Association for Cardio-Thoracic Surgery, 2021.

Abstract

OBJECTIVESThe aim of this study was to evaluate the lesion size and depth of radiofrequency (RF) ablation in a simultaneous biparietal bidirectional bipolar (SBB) approach, compared to a simultaneous and staged unipolar and uniparietal bipolar setup [simultaneous uniparietal bipolar (SiUB) and staged uniparietal bipolar (StUB), respectively].METHODSFresh left atrial porcine tissue was mounted into the ABLA-BOX simulator. Different ablation approaches were tested: (i) SBB: a concept consisting of SBB endo-epicardial ablation, (ii) SiUB: simultaneous epicardial uniparietal bipolar and endocardial unipolar ablation and (iii) StUB: staged epicardial uniparietal bipolar and endocardial unipolar ablation. In the StUB setup, a 1-h interval between the epi-endo ablation was respected.RESULTSTransmural lesions were present in 90% of the bipolar biparietal ablations, yet no full transmurality was observed in the simultaneous nor in the staged unipolar with uniparietal bipolar ablation group. In SBB, the area and volume of the ablation lesions were smaller (523.33 mm2/mm and 52.33 mm3/mm, respectively) than in SiUB (588.17 mm2/mm and 58.81 mm3/mm, respectively) and StUB (583.76 mm2/mm and 58.37 mm3/mm, P = 0.044). Also, in SBB, the overall, epicardial and endocardial maximum diameters of the lesions (1.59, 1.57 and 1.52 mm; respectively) were smaller than in SiUB (2.38, 2.26 and 2.33 mm; respectively) and in StUB (2.36, 2.28 and 2.14 mm; respectively, all P CONCLUSIONSAlthough bipolar biparietal bidirectional RF ablation results in smaller lesions than uniparietal bipolar and unipolar ablation, their capacity to penetrate the tissue is much higher. Moreover, in uniparietal RF applications, the energy spreads in the superficial layers of the tissue but fails to penetrate. Therefore, the degree of transmurality is much higher when using such a ‘truly bipolar’ ablation approach.

Details

Language :
English
ISSN :
15699293
Database :
OpenAIRE
Journal :
Interact Cardiovasc Thorac Surg, Interactive Cardiovascular and Thoracic Surgery, 33(1), 34-42. Oxford University Press
Accession number :
edsair.doi.dedup.....f81ef902acd11b242b06a85dbd39d1aa
Full Text :
https://doi.org/10.1093/icvts/ivab047