Perpendicular Catheter Orientation During Papillary Muscle Ablation Results in Larger, Deeper Lesions

Overview

Journal J Cardiovasc Electrophysiol

Specialties Cardiology & Vascular Diseases
Physiology

Date 2022 Feb 8

PMID 35133050

Authors

Udi Nussinovitch

Paul Wang

Sanjiv Narayan

Mohan Viswanathan

Nitish Badhwar

Lijun Zheng

William H Sauer

Duy T Nguyen

Affiliations

Soon will be listed here.

Abstract

Introduction: Ablation of papillary muscles (PMs) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect optimal radiofrequency (RF) delivery. Yet, no previous study investigated the association between catheter orientation and PM lesion size. We evaluated ablation lesion characteristics with various catheter orientations relative to the PM tissue during open irrigated ablation, using a standardized, experimental setting.

Methods: Viable bovine PM was positioned on a load cell in a circulating saline bath. RF ablation was performed over PM tissue at 50 W, with the open irrigated catheter positioned either perpendicular or parallel to the PM surface. Applied force was 10 g. Ablation lesions were sectioned and underwent quantitative morphometric analysis.

Results: A catheter position oriented directly perpendicular to the PM tissue resulted in the largest ablation lesion volumes and depths compared with ablation with the catheter parallel to PM tissue (75.26 ± 8.40 mm vs. 34.04 ± 2.91 mm , p < .001) and (3.33 ± 0.18 mm vs. 2.24 ± 0.10 mm, p < .001), respectively. There were no significant differences in initial impedance, peak voltage, peak current, or overall decrease in impedance among groups. Parallel catheter orientation resulted in higher peak temperature (41.33 ± 0.28°C vs. 40.28 ± 0.24°C, p = .003), yet, there were no steam pops in either group.

Conclusion: For PM ablation, catheter orientation perpendicular to the PM tissue achieves more effective and larger ablation lesions, with greater lesion depth. This may have implications for the chosen ventricular access approach, the type of catheter used, consideration for remote navigation, and steerable sheaths.

Citing Articles

Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias.

Chen T, Chang L, Rong B, Zhang K, Fan G, Kong J J Clin Med. 2023; 12(9).

PMID: 37176594 PMC: 10179325. DOI: 10.3390/jcm12093154.

Ambient circulation surrounding an ablation catheter tip affects ablation lesion characteristics.

Nussinovitch U, Wang P, Babakhanian M, Narayan S, Viswanathan M, Badhwar N J Cardiovasc Electrophysiol. 2023; 34(4):918-927.

PMID: 36852908 PMC: 10115146. DOI: 10.1111/jce.15874.

Needle-Tipped Catheter Ablation of Papillary Muscle Results in Deeper and Larger Ablation Lesions.

Nussinovitch U, Wang P, Babakhanian M, Narayan S, Viswanathan M, Badhwar N J Cardiovasc Transl Res. 2022; 16(3):636-643.

PMID: 36264437 PMC: 10115905. DOI: 10.1007/s12265-022-10331-z.

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