Evaluation of radiofrequency catheter ablation settings for variable atrial tissue depth and flow conditions

Desmond Dillon-Murphy; David Nordsletten; Navjeevan Soor; Henry Chubb; Mark O'Neill; Adelaide De Vecchi; Oleg Aslanidi

doi:10.22489/CinC.2017.212-082

Evaluation of radiofrequency catheter ablation settings for variable atrial tissue depth and flow conditions

Desmond Dillon-Murphy, David Nordsletten, Navjeevan Soor, Henry Chubb, Mark O'Neill, Adelaide De Vecchi, Oleg Aslanidi^*

^*Corresponding author for this work

Imperial College London

Research output: Contribution to journal › Conference paper › peer-review

2 Citations (Scopus)

152 Downloads (Pure)

Abstract

Catheter ablation (CA) is a potentially curative therapy for paroxysmal atrial fibrillation, however up to 50% of patients may require a repeat procedure to achieve the best results. While this may be due to insufficient radiofrequency (RF) energy delivery to achieve transmural, contiguous ablation lesions (TAL), excessive RF application may result in extracardiac injury and complications. We aim to evaluate optimal RFCA temperature settings for variable atrial tissue depth and blood flow conditions. Heat spread in atrial tissue and blood was simulated using the Pennes bioheat equation with an additional convective term in the blood. The minimum catheter contact time required for TAL formation increased with increasing either atrial wall thickness (AWT) or laminar flow velocity (LFV). Thus, during ablation of atrial tissue regions with AWT of 1 and 5.5 mm and LFV of 0.1 m/s, TALs were formed in 12 and 153 s, respectively. When LFV was increased to 1.2 m/s, the TAL formation time increased to 21 and 174 s. The maximum temperature in the blood volume stayed below the coagulation risk threshold of 70°C for all AWT values with LFVs over 0.6 m/s, but raised above the threshold for LFV ≦ 0.6 m/s and AWT > 1.5 mm. This study demonstrates the potential for optimizing RFCA settings according to atrial tissue depth and flow, which may improve the efficacy of RFCA therapy.

Original language	English
Article number	17681512
Pages (from-to)	1-4
Number of pages	4
Journal	Computing in Cardiology
Volume	44
Early online date	5 Apr 2018
DOIs	https://doi.org/10.22489/CinC.2017.212-082
Publication status	E-pub ahead of print - 5 Apr 2018

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Evaluation of radiofrequency catheter_DILLON-MURPHY_Firstonline24September2017_GOLD VoR (CC BYFinal published version, 6.12 MBLicence: CC BY

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title = "Evaluation of radiofrequency catheter ablation settings for variable atrial tissue depth and flow conditions",

abstract = "Catheter ablation (CA) is a potentially curative therapy for paroxysmal atrial fibrillation, however up to 50% of patients may require a repeat procedure to achieve the best results. While this may be due to insufficient radiofrequency (RF) energy delivery to achieve transmural, contiguous ablation lesions (TAL), excessive RF application may result in extracardiac injury and complications. We aim to evaluate optimal RFCA temperature settings for variable atrial tissue depth and blood flow conditions. Heat spread in atrial tissue and blood was simulated using the Pennes bioheat equation with an additional convective term in the blood. The minimum catheter contact time required for TAL formation increased with increasing either atrial wall thickness (AWT) or laminar flow velocity (LFV). Thus, during ablation of atrial tissue regions with AWT of 1 and 5.5 mm and LFV of 0.1 m/s, TALs were formed in 12 and 153 s, respectively. When LFV was increased to 1.2 m/s, the TAL formation time increased to 21 and 174 s. The maximum temperature in the blood volume stayed below the coagulation risk threshold of 70°C for all AWT values with LFVs over 0.6 m/s, but raised above the threshold for LFV ≦ 0.6 m/s and AWT > 1.5 mm. This study demonstrates the potential for optimizing RFCA settings according to atrial tissue depth and flow, which may improve the efficacy of RFCA therapy.",

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AU - Dillon-Murphy, Desmond

AU - Nordsletten, David

AU - Soor, Navjeevan

AU - Chubb, Henry

AU - O'Neill, Mark

AU - De Vecchi, Adelaide

AU - Aslanidi, Oleg

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N2 - Catheter ablation (CA) is a potentially curative therapy for paroxysmal atrial fibrillation, however up to 50% of patients may require a repeat procedure to achieve the best results. While this may be due to insufficient radiofrequency (RF) energy delivery to achieve transmural, contiguous ablation lesions (TAL), excessive RF application may result in extracardiac injury and complications. We aim to evaluate optimal RFCA temperature settings for variable atrial tissue depth and blood flow conditions. Heat spread in atrial tissue and blood was simulated using the Pennes bioheat equation with an additional convective term in the blood. The minimum catheter contact time required for TAL formation increased with increasing either atrial wall thickness (AWT) or laminar flow velocity (LFV). Thus, during ablation of atrial tissue regions with AWT of 1 and 5.5 mm and LFV of 0.1 m/s, TALs were formed in 12 and 153 s, respectively. When LFV was increased to 1.2 m/s, the TAL formation time increased to 21 and 174 s. The maximum temperature in the blood volume stayed below the coagulation risk threshold of 70°C for all AWT values with LFVs over 0.6 m/s, but raised above the threshold for LFV ≦ 0.6 m/s and AWT > 1.5 mm. This study demonstrates the potential for optimizing RFCA settings according to atrial tissue depth and flow, which may improve the efficacy of RFCA therapy.

AB - Catheter ablation (CA) is a potentially curative therapy for paroxysmal atrial fibrillation, however up to 50% of patients may require a repeat procedure to achieve the best results. While this may be due to insufficient radiofrequency (RF) energy delivery to achieve transmural, contiguous ablation lesions (TAL), excessive RF application may result in extracardiac injury and complications. We aim to evaluate optimal RFCA temperature settings for variable atrial tissue depth and blood flow conditions. Heat spread in atrial tissue and blood was simulated using the Pennes bioheat equation with an additional convective term in the blood. The minimum catheter contact time required for TAL formation increased with increasing either atrial wall thickness (AWT) or laminar flow velocity (LFV). Thus, during ablation of atrial tissue regions with AWT of 1 and 5.5 mm and LFV of 0.1 m/s, TALs were formed in 12 and 153 s, respectively. When LFV was increased to 1.2 m/s, the TAL formation time increased to 21 and 174 s. The maximum temperature in the blood volume stayed below the coagulation risk threshold of 70°C for all AWT values with LFVs over 0.6 m/s, but raised above the threshold for LFV ≦ 0.6 m/s and AWT > 1.5 mm. This study demonstrates the potential for optimizing RFCA settings according to atrial tissue depth and flow, which may improve the efficacy of RFCA therapy.

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Evaluation of radiofrequency catheter ablation settings for variable atrial tissue depth and flow conditions

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