Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation
BackgroundInterlesion gaps and transmurality of lesions after catheter ablation can precipitate suboptimal efficacy in preventing arrhythmias.AimsWe aim to assess predictors of acute transmural lesion formation and the interlesion distance threshold for creating a continuous, chronic scar after vent...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.920539/full |
| _version_ | 1811343694640447488 |
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| author | Abdel Hadi El Hajjar Mario Mekhael Chao Huang Charbel Noujaim Yichi Zhang Eugene Kholmovski Eugene Kholmovski Tarek Ayoub Chan Ho Lim Nassir Marrouche |
| author_facet | Abdel Hadi El Hajjar Mario Mekhael Chao Huang Charbel Noujaim Yichi Zhang Eugene Kholmovski Eugene Kholmovski Tarek Ayoub Chan Ho Lim Nassir Marrouche |
| author_sort | Abdel Hadi El Hajjar |
| collection | DOAJ |
| description | BackgroundInterlesion gaps and transmurality of lesions after catheter ablation can precipitate suboptimal efficacy in preventing arrhythmias.AimsWe aim to assess predictors of acute transmural lesion formation and the interlesion distance threshold for creating a continuous, chronic scar after ventricular ablation.Materials and MethodsAblation procedures were performed on 7 canines followed by late gadolinium enhancement MRI (LGE-MRI). Transmurality of lesions was assessed by 2 independent operators. Ablation parameters such as duration (s), power (W), temperature (C), contact force (CF) (g), were collected for each ablation point. After 7-12 weeks, LGE-MRI was performed, followed by euthanasia, and heart excision. Some lesions were created in pair. Lesion pairs were spaced 7-21 mm apart as measured by Electroanatomic mapping (EAM), with different operating parameters (power 35 or 50W, duration of energy delivery 10, 20 or 30s and contact force of 10g or above). We performed a logistic regression analysis to determine predictors of transmural lesion formation.ResultsEighty-one radiofrequency ablation were performed in total [33 in the Left ventricle (LV) and 48 in the Right ventricle (RV)]. Higher CF was a significant predictor of transmural lesion formation (β = 0.15, OR = 1.16, 95% CI [1.03 – 1.3], p = 0.01), and lesions delivered in the RV were more frequently transmural than lesions delivered in the LV (β = −2.43, OR = 0.09, 95%CI [0.02 – 0.34], p < 0.001). For the paired analysis, thirty-eight lesions were created contiguously: fourteen connected lesions and twenty-four unconnected lesions. EAM distance was significantly larger in unconnected lesions than connected lesions (16.17 ± 0.92 mm vs. 11.51 ± 0.68 mm, respectively, p < 0.05). We concluded that an interlesion distance of less than 10 mm is required to prevent gap formation. Average volumes in unconnected lesions (n = 24) at the acute and chronic stages were 0.55 ± 0.11 cm3 and 0.20 ± 0.02 cm3, respectively. On average, lesion volumes were 64% (p < 0.05) smaller at the chronic stage compared to the acute stage. Among connected lesions (n = 14), we observed a volume of 1.19 ± 0.8 cm3 and 0.39 ± 0.15 cm3 at the acute and chronic stages, respectively. These connected lesions reduced in volume by 67% on average.ConclusionTo create contiguous scars on the ventricular endocardial surface, paired lesions should be spaced less than ten millimeters apart. Higher contact force should be used in ventricular ablation to create transmural lesions. |
| first_indexed | 2024-04-13T19:33:18Z |
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| language | English |
| last_indexed | 2024-04-13T19:33:18Z |
| publishDate | 2022-06-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-6a27eb5b20b54e7c8cf7b9beaa0a4b502022-12-22T02:33:06ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-06-01910.3389/fcvm.2022.920539920539Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter AblationAbdel Hadi El Hajjar0Mario Mekhael1Chao Huang2Charbel Noujaim3Yichi Zhang4Eugene Kholmovski5Eugene Kholmovski6Tarek Ayoub7Chan Ho Lim8Nassir Marrouche9Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United StatesBackgroundInterlesion gaps and transmurality of lesions after catheter ablation can precipitate suboptimal efficacy in preventing arrhythmias.AimsWe aim to assess predictors of acute transmural lesion formation and the interlesion distance threshold for creating a continuous, chronic scar after ventricular ablation.Materials and MethodsAblation procedures were performed on 7 canines followed by late gadolinium enhancement MRI (LGE-MRI). Transmurality of lesions was assessed by 2 independent operators. Ablation parameters such as duration (s), power (W), temperature (C), contact force (CF) (g), were collected for each ablation point. After 7-12 weeks, LGE-MRI was performed, followed by euthanasia, and heart excision. Some lesions were created in pair. Lesion pairs were spaced 7-21 mm apart as measured by Electroanatomic mapping (EAM), with different operating parameters (power 35 or 50W, duration of energy delivery 10, 20 or 30s and contact force of 10g or above). We performed a logistic regression analysis to determine predictors of transmural lesion formation.ResultsEighty-one radiofrequency ablation were performed in total [33 in the Left ventricle (LV) and 48 in the Right ventricle (RV)]. Higher CF was a significant predictor of transmural lesion formation (β = 0.15, OR = 1.16, 95% CI [1.03 – 1.3], p = 0.01), and lesions delivered in the RV were more frequently transmural than lesions delivered in the LV (β = −2.43, OR = 0.09, 95%CI [0.02 – 0.34], p < 0.001). For the paired analysis, thirty-eight lesions were created contiguously: fourteen connected lesions and twenty-four unconnected lesions. EAM distance was significantly larger in unconnected lesions than connected lesions (16.17 ± 0.92 mm vs. 11.51 ± 0.68 mm, respectively, p < 0.05). We concluded that an interlesion distance of less than 10 mm is required to prevent gap formation. Average volumes in unconnected lesions (n = 24) at the acute and chronic stages were 0.55 ± 0.11 cm3 and 0.20 ± 0.02 cm3, respectively. On average, lesion volumes were 64% (p < 0.05) smaller at the chronic stage compared to the acute stage. Among connected lesions (n = 14), we observed a volume of 1.19 ± 0.8 cm3 and 0.39 ± 0.15 cm3 at the acute and chronic stages, respectively. These connected lesions reduced in volume by 67% on average.ConclusionTo create contiguous scars on the ventricular endocardial surface, paired lesions should be spaced less than ten millimeters apart. Higher contact force should be used in ventricular ablation to create transmural lesions.https://www.frontiersin.org/articles/10.3389/fcvm.2022.920539/fullventricular arrhythmiacatheter ablationtransmuralityinterlesion distancecontiguous lesions |
| spellingShingle | Abdel Hadi El Hajjar Mario Mekhael Chao Huang Charbel Noujaim Yichi Zhang Eugene Kholmovski Eugene Kholmovski Tarek Ayoub Chan Ho Lim Nassir Marrouche Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation Frontiers in Cardiovascular Medicine ventricular arrhythmia catheter ablation transmurality interlesion distance contiguous lesions |
| title | Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation |
| title_full | Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation |
| title_fullStr | Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation |
| title_full_unstemmed | Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation |
| title_short | Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation |
| title_sort | predictors of lesions contiguity and transmurality in canine ventricular models after catheter ablation |
| topic | ventricular arrhythmia catheter ablation transmurality interlesion distance contiguous lesions |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.920539/full |
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