Chronic performance of a novel radiofrequency ablation device on the beating heart: Limitations of conduction delay to assess transmurality Anson M.

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Presentation transcript:

Chronic performance of a novel radiofrequency ablation device on the beating heart: Limitations of conduction delay to assess transmurality Anson M. Lee, MD, Abdulhameed Aziz, MD, Kal L. Clark, BS, Richard B. Schuessler, PhD, Ralph J. Damiano, MD The Journal of Thoracic and Cardiovascular Surgery Volume 144, Issue 4, Pages 859-865 (October 2012) DOI: 10.1016/j.jtcvs.2012.01.001 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Lesion set used in the study. ∗Sites of pacing, placed to initiate activation on either side of the planned AtriCure Coolrail (AtriCure Inc, West Chester, Ohio) device line of ablation (dotted line). IVC, Inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 859-865DOI: (10.1016/j.jtcvs.2012.01.001) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The AtriCure Coolrail device. The 2 electrodes are hollow, and sterile water is circulated internally to provide cooling of the electrode–tissue interface during ablation. They are 3 mm wide and 30 mm long. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 859-865DOI: (10.1016/j.jtcvs.2012.01.001) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Lesion depth is plotted against tissue thickness. Transmural ablations lie along the line of identity where lesion depth is equal to tissue thickness. Dots that fall off this line represent ablations that failed to achieve transmurality. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 859-865DOI: (10.1016/j.jtcvs.2012.01.001) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Representative sequence of activation maps demonstrating normal paced activation preablation, acute conduction block with a change in activation sequence around the ablation line (dotted line) acutely, and recovery of conduction through nontransmural gaps chronically (4 weeks). Conduction times were measured between the 2 points marked by asterisks. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 859-865DOI: (10.1016/j.jtcvs.2012.01.001) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Conduction time across the Coolrail lesion line (see Figure 4) is plotted for the preablation, acute postablation, and chronic postablation periods. There was no statistical difference between conduction times preablation and chronic postablation 4 weeks after the initial operation (P = .242). The Journal of Thoracic and Cardiovascular Surgery 2012 144, 859-865DOI: (10.1016/j.jtcvs.2012.01.001) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions