Determination of lesion size by ultrasound during radiofrequency catheter ablation.

The catheter tip temperature that is used to control the radiofrequency generator output poorly correlates to lesion size. We, therefore, evaluated lesions created in vitro using a B-mode ultrasound imaging device as a potential means to assess lesion generation during RF applications non-invasively. Porcine ventricular tissue was immersed in saline solution at 37 degrees C. The catheter was fixed in a holder and positioned in a parallel orientation to the tissue with an array transducer (7.5 MHz) app. 3 cm above the tissue. Lesions were produced either in a temperature controlled mode with a 4-mm tip catheter with different target temperatures (50, 60, 70 and 80 degrees C, 80 W maximum output) or in a power controlled mode (25, 50 and 75 W, 20 ml/min irrigation flow) using an irrigated tip catheter. Different contact forces (0.5 N, 1.0 N) were tested, and RF was delivered for 60 s. A total of 138 lesions was produced. Out of these, 128 could be identified on the ultrasound image. The lesion depth and volume was on average 4.1 +/- 1.6 mm and 52 +/- 53 mm3 as determined by ultrasound and 3.9 +/- 1.7 mm and 52 +/- 55 mm3 as measured thereafter, respectively. A linear correlation between the lesion size determined by ultrasound and that measured thereafter was demonstrated with a correlation coefficient of r = 0.87 for lesion depth and r = 0.93 for lesion volume. We conclude that lesions can be assessed by B-mode ultrasound imaging.     

External irrigation of a non-irrigated ablation catheter for effective AV node ablation during conduction system pacing

Ablation using non-irrigated catheter can lead to rapid rise in temperature of electrode tissue interface from tissue desiccation, steam and coagulum formation and this may limit power delivery and lesion size. We present a novel technique of external irrigation through the long sheath while using a non-irrigated ablation catheter during AV Node ablation and conduction system pacing. By bringing the long sheath closer to the tip of non-irrigated catheter and injecting cold normal saline allows cooling of electrode tissue interface leading to increase in power delivery resulting in a deeper lesion.     

Automatic termination of radiofrequency energy upon catheter dislocation.

Since 1987 radiofrequency (RF) catheter ablation has proven to be an effective treatment for many cardiac arrhythmias. However, catheter dislocation during RF delivery may result in an unintentional heating of healthy non-arrhythmogenic tissue. Therefore, a device was developed (15 cm x 9 cm x 3 cm) consisting of a microprocessor, powered by a 9 V battery and to be connected between the indifferent cable of the RF generator and the patient's back electrode that continuously reads the electrode position information using a 3 dimensional electrode visualization system (LocaLisa). A red light indicates a sudden change in electrode position and an electronic switch is activated by the software to interrupt the connection between the indifferent electrode and the RF generator resulting in a high impedance shutdown and termination of RF energy delivery. Four different sensitivity settings (10 is most and 100 is least sensitive) can be selected and were tested in an in vitro tank setup during electrode dragging speeds of 0.5 to 20 cm/sec. For the sensitivity levels 10, 20, 50 and 100, an immediate termination of RF (Atakr II, Medtronic, 25 W) was demonstrated for an electrode dragging speed of greater or equal than 1, 2, 5 and 10 cm/sec, respectively. We conclude that the developed device may improve safety during ablation procedures of cardiac arrhythmias.     

Computational Modeling of Open-Irrigated Electrodes for Radiofrequency Cardiac Ablation Including Blood Motion-Saline Flow Interaction

Radiofrequency catheter ablation (RFCA) is a routine treatment for cardiac arrhythmias. During RFCA, the electrode-tissue interface temperature should be kept below 80°C to avoid thrombus formation. Open-irrigated electrodes facilitate power delivery while keeping low temperatures around the catheter. No computational model of an open-irrigated electrode in endocardial RFCA accounting for both the saline irrigation flow and the blood motion in the cardiac chamber has been proposed yet. We present the first computational model including both effects at once. The model has been validated against existing experimental results. Computational results showed that the surface lesion width and blood temperature are affected by both the electrode design and the irrigation flow rate. Smaller surface lesion widths and blood temperatures are obtained with higher irrigation flow rate, while the lesion depth is not affected by changing the irrigation flow rate. Larger lesions are obtained with increasing power and the electrode-tissue contact. Also, larger lesions are obtained when electrode is placed horizontally. Overall, the computational findings are in close agreement with previous experimental results providing an excellent tool for future catheter research.     

Mechanical compliance of the endocardium

Radio-frequency (RF) ablation is an accepted treatment for cardiac arrhythmias related to abnormal focal cardiac substrate. The penetration depth of the electrode into the endocardium affects lesion size, a critical determinant of success of RF ablation. We measured the relation between the mechanical compliance and the penetration depth of RF ablation catheter electrode at frequently ablated areas of the endocardium and examined the influence of time after death on mechanical properties of the tissue. We measured force versus time for eight insertion depths of the catheter electrode into full-thickness endocardial samples derived from the mitral valve annulus, the left ventricular free wall and the tricuspid valve annulus. We varied the time after death at 15, 40 min, 3, 8, and 18 h and repeated our measurements. At 15 min after death, the first 0.5 mm penetration depth caused the fastest relaxation at 55 s. Force decay decreased dramatically at 15 min after death as the penetration depth increased from 0.5 to 4 mm. We used the force data sampled at 60 s after insertion to approximate the elasticity. We observed the relations between the force versus the insertion depth. The force increased by a factor of 5 for the mitral valve annulus and 8 for the left free wall from 15 min to 18 h. We derived coefficients of a second-order polynomial equation relating the force data to insertion depth with R²>0.99.     

Real‐time optical spectroscopic monitoring of nonirrigated lesion progression within atrial and ventricular tissues

Despite considerable advances in guidance of radiofrequency ablation (RFA) therapy for the treatment of cardiac arrhythmias, success rates have been hampered by a lack of tools for precise intraoperative evaluation of lesion extent. Near‐infrared spectroscopic (NIRS) techniques are sensitive to tissue structural and biomolecular properties, characteristics that are directly altered by radiofrequency (RF) treatment. In this work, a combined NIRS‐RFA catheter is developed for real‐time monitoring of tissue reflectance during RF energy delivery. An algorithm is proposed for processing NIR spectra to approximate nonirrigated lesion depth in both atrial and ventricular tissues. The probe optical geometry was designed to bias measurement influence toward absorption enabling enhanced sensitivity to changes in tissue composition. A set of parameters termed “lesion optical indices” are defined encapsulating spectral differences between ablated and unablated tissue. Utilizing these features, a model for real‐time tissue spectra classification and lesion size estimation is presented. Experimental validation conducted within freshly excised porcine cardiac specimens showed strong concordance between algorithm estimates and post‐hoc tissue assessment.      

Investigation of the influence of blood flow rate on large vessel cooling in hepatic radiofrequency ablation.

Radiofrequency (RF) ablation using high-frequency current has become an important treatment method for patients with non-resectable liver tumors. Tumor recurrence is associated with tissue cooling in the proximity of large blood vessels. This study investigated the influence of blood flow rate on tissue temperature and lesion size during monopolar RF ablation at a distance of 10 mm from single 4- and 6-mm vessels using two different approaches: 1) an ex vivo blood perfusion circuit including an artificial vessel inserted into porcine liver tissue was developed; and 2) a finite element method (FEM) model was created using a novel simplified modeling technique for large blood vessels. Blood temperatures at the inflow/outflow of the vessel and tissue temperatures at 10 and 20 mm from the electrode tip were measured in the ex vivo set-up. Tissue temperature, blood temperature and lesion size were analyzed under physiological, increased and reduced blood-flow conditions. The results show that changes in blood flow rate in large vessels do not significantly affect tissue temperature and lesion size far away from the vessel. Monopolar ablation could not produce lesions surrounding the vessel due to the strong heat-sink effect. Simulated tissue temperatures correlated well with ex vivo measurements, supporting the FEM model.     

Tissue temperature feedback control of power: the key to successful ablation

Multiple ablation technologies are used to treat atrial fibrillation during cardiac operations. All such ablation technologies use locally induced temperature extremes (>50°C or <-20°C) to kill tissue and create a lesion pattern in the atria which blocks activation pathways that initiate and sustain atrial fibrillation. The technologies used to heat tissue have included radiofrequency (RF), microwave, high-intensity focused ultrasound, and infrared laser. RF accounts for more than 95% of the heating-based ablation technology used by cardiac surgeons. Energy delivery with RF is easier to control than with some other technologies, the heating produced by the energy source is well understood, and manufacturing costs are not excessive. Whichever heating technology is used, control of energy delivery is required to ensure both safe and effective heating of the targeted tissue. All targeted tissue needs to be heated above 50°C to achieve cell death. However, the targeted tissue should not be heated above 100°C, as this can cause perforation due to a steam pop. In addition, adjacent noncardiac tissues must not be damaged during the ablation procedure. The best method to achieve this control uses direct measurement of tissue temperature, because the tissue temperature defines both the safe and effective limits for the ablative process.     

Advanced fully integrated radiofrequency/optical-coherence-tomography irrigated catheter for atrial fibrillation ablation

The inability of current catheter ablation procedures to accurately monitor lesion formation limits their safety and efficacy. An advanced fully integrated radiofrequency (RF)/optical coherence tomography (OCT) ablation catheter is developed, which enables real-time monitoring during ablation. An OCT fiber array is especially designed, developed and integrated into an off-the-shelf irrigated RF ablation catheter. In-vitro experimental studies performed on poultry and ovine hearts demonstrate the ability of the integrated RF/OCT system to provide information on the quality and orientation of catheter/wall contact. Experimental results show that adipose tissue can be accurately identified from normal myocardial tissue with 94% accuracy and lesion formation is monitored with an overall accuracy of 93%. The ability to predict pop events is also demonstrated, with an accuracy of 86%.     

近红外光谱技术在猫脑射频热凝毁损中的应用研究

目的：探索近红外光谱（nears）技术用于立体定向靶点毁损术中实时监测的可行性。方法：利用猫脑建立体内不同毁损时间、温度下的毁损灶体积模型,通过病理检测及近红外光谱仪观察并记录脑组织靶点毁损时的NIRS尤其是优化散射系数（）的变化情况。结果：不同温度、不同时间温度点下NIRS出现特征性变化曲线。并建立时间、温度及三维模型。结论：利用NIRS实时活体在位监测猫脑射频神经核团毁损术是科学、可行的,优化散射系数是监测的良好指标,比以往单凭经验的作法更科学、更准确。     

Stereotactic radiofrequency lesion making

The physical principles of radiofrequency (RF) lesion making in stereotactic neurosurgery are summarized. Empirical data are given on the relationship between lesion size and lesioning parameters. Currently accepted ranges of lesioning parameters for selected stereotactic procedures are discussed. Advanced RF lesion electrode designs are described which improve the capabilities to reach and confirm targets.     

射频消融中温度场建立的探讨

提出了建立在射频电流组织加热和热传导基础上的射频消融中温度场建立的理论模型,初步分析了血流对温度分布提影响,得出稳定后的温度场在径向的分布基本上与ｒ及血流速度成反比;近场的温度场的建立过程的时间常数与血流速度成反比。     

Importance of physical parameters for the effectiveness of radiofrequency catheter ablation]

Radiofrequency catheter ablation has been shown to be an effective form of treatment of accessory pathways in patients with WPW-syndrome and other supraventricular tachycardias. However, the biophysical parameters so far used in vivo neither correlated with the size of the myocardial lesion nor did they provide any information about contact of the electrode with the myocardial wall. In this study, 104 radiofrequency energy applications were performed on excised pig myocardium in circulating heparinized pig blood, and in blood alone, and root mean square (rms) voltage, current and phase angle were measured using a specially developed device. The calculated effective power and output power differed by only 2-7% measured at the point of maximum current during coagulation. A progressive drop in current following a rise in impedance led to a phase shift of more than 80 degrees with a decrease in effective power to 17% of the output power. Hence, apparent output power was mainly ineffective power. The time-dependent variations of phase angle, impedance and current were found to be useful for distinguishing between the coagulated media. These results show that physical parameters measured during radio-frequency catheter ablation may help to monitor electrode position in the clinical situation and reduce the number of ineffective energy applications.     

Low-current medium-pressure RF discharge with electron photoemission in the electrode sheath and penetration of the sheath electrons into the discharge column

A model is developed for simulating a low-current moderate-pressure RF discharge with allowance for such characteristic discharge properties as the existence of two sheaths near both electrodes throughout the RF field period; the formation of an electron cloud at the sheath boundary that periodically fills the sheath and leaves it, depending on the phase of the applied RF voltage; the production by the sheath electrons of metastable gas particles that interact with the cloud electrons during subsequent field periods, followed by the excitation of metastable states to the emitting levels; the formation of a sheath in a low-current RF discharge due to the overlap of the secondary electron avalanches triggered by electron photoemission from the electrode surface; and the conditions under which the sheath electrons penetrate into the positive column and accumulate there, which makes, thereby making a low-current RF discharge similar to a non-self-sustained discharge. The parameters of the sheath in a low-current RF discharge are determined by the conditions under which the electron photoemission current from the electrode surface in the sheath is self-sustaining and, like the parameters of the positive discharge column, depend on the sort of gas, the gas pressure, the frequency of the applied RF field, and the interelectrode distance. The results of calculating the parameters of the sheath and column of a low-current RF discharge for nitrogen and helium at different pressures, as well as for different field frequencies and interelectrode distances, are presented and are compared with the experimental data.     

Detailing Radio Frequency Heating Induced by Coronary Stents: A 7.0 Tesla Magnetic Resonance Study

The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential to induce local heating, which might cause tissue damage. Realizing these constraints, this work examines RF heating effects of stents using electro-magnetic field (EMF) simulations and phantoms with properties that mimic myocardium. For this purpose, RF power deposition that exceeds the clinical limits was induced by a dedicated birdcage coil. Fiber optic probes and MR thermometry were applied for temperature monitoring using agarose phantoms containing copper tubes or coronary stents. The results demonstrate an agreement between RF heating induced temperature changes derived from EMF simulations versus MR thermometry. The birdcage coil tailored for RF heating was capable of irradiating power exceeding the specific-absorption rate (SAR) limits defined by the IEC guidelines by a factor of three. This setup afforded RF induced temperature changes up to +27 K in a reference phantom. The maximum extra temperature increase, induced by a copper tube or a coronary stent was less than 3 K. The coronary stents examined showed an RF heating behavior similar to a copper tube. Our results suggest that, if IEC guidelines for local/global SAR are followed, the extra RF heating induced in myocardial tissue by stents may not be significant versus the baseline heating induced by the energy deposited by a tailored cardiac transmit RF coil at 7.0 T, and may be smaller if not insignificant than the extra RF heating observed under the circumstances used in this study.     

The effects of fat layer on temperature distribution during microwave atrial fibrillation catheter ablation

Abstract

To investigate the effects of fat layer on the temperature distribution during microwave atrial fibrillation catheter ablation in the conditions of different ablation time; 3D finite element models (fat layer and no fat layer) were built, and temperature distribution was obtained based on coupled electromagnetic-thermal analysis at 2.45?GHz and 30?W of microwave power. Results shown: in the endocardial ablation, the existence of the fat layer did not affect the shape of the 50?°C contour before 30?s. The increase speed of depth became quite slowly in the model with fat layer after 30?s. When ablation depth needed fixed, there are no significant effect on effectively ablation depth whether fat layer over or not. However, the existence of fat layer makes the temperature lower in the myocardium, and maximum temperature point closer to the myocardium surface. What is more, in the model with fat layer, effective ablation reach lower maximum temperature and the shallower depth of 50?°C contour. But there are larger ablation axial length and transverse width. In this case, doctor should ensure safety of normal cardiac tissue around the target tissue. In the epicardial ablation, the existence of fat layer seriously affects result of the microwave ablation. The epicardial ablation needs more heating time to create lesion. But epicardial ablation can be better controlled in the shape of effective ablation area because of the slowly increase of target variables after the appearing of 50?°C contour. Doctor can choose endocardial or epicardial ablation in different case of clinic requirement.     

Thermal models for microwave hazards and their role in standards development

We consider the thermal response of the body to radiofrequency (RF) energy, with emphasis on partial-body exposure, to assess potential thermal hazards. The thermal analysis is based on Pennes' bioheat equation. In this model, the thermal response is governed by two time constants. One (τ₁) pertains to heat convection by blood flow and is (for physiologically normal perfusion rates) on the order of 3 min. The second (τ₂) characterizes heat conduction, and varies as the square of a distance that characterizes the spatial extent of the heating. We examine three idealized cases. The first is a region of tissue with an insulated surface, subject to irradiation with an exponentially decreasing SAR, which models a large surface area of tissue exposed to microwaves. The second is a region of tissue in contact with a hemispherical electrode that passes current into it, which models exposure from contact with a conductor. The third is a region of tissue with an insulated surface, subject to heating from a dipole located close to it. In all three cases, we estimate the maximum steady-state temperature increase as a function of the relevant electrical and thermal parameters and the thresholds for thermal hazard. We conclude that thermal models are a potentially fruitful but underutilized means of analyzing thermal hazards from RF fields. A quantitative analysis of such hazards enables the development of data-based uncertainty factors, which can replace arbitrary “safety factors” in developing exposure limits. Finally, we comment on the need to marry quantitative modeling of data and risk assessment, and to incorporate contemporary approaches to risk assessment into RF standards development. Bioelectromagnetics 20:52–63, 1999. © 1999 Wiley-Liss, Inc.     

RF lesion generation.

Although the technique of RF lesion generation is a well-established medical technique, most professionals using it do not understand the basic principles of electronics by which the phenomenon occurs. A review of this with special attention to the 'indifferent' or 'dispersive' electrode would lead to better practice and less adverse effects, such as patient skin burns.     

Properties of a low-pressure inductive RF discharge II: Mathematical simulations

Self-consistent numerical simulations of a low-pressure inductive RF discharge have been carried out. It is shown that, on the one hand, the plasma parameters are determined by the RF power absorbed in the plasma and, on the other, they themselves govern the power absorption. This results in a nonmonotonic dependence of the plasma parameters on the magnetic field, as well as in discharge disruptions, similar to those observed experimentally in such discharges. An inductive RF discharge with a capacitive component is simulated. The experimentally observed characteristic properties of the discharges are explained based on the regular features of the absorption of RF power in the plasma. Traditional inductive plasma sources (both without and with a magnetic field) are considered.     

近红外光谱技术在猫脑射频热凝毁损中的应用研究

目的:探索近红外光谱(nears)技术用于立体定向靶点毁损术中实时监测的可行性。方法:利用猫脑建立体内不同毁损时间、温度下的毁损灶体积模型,通过病理检测及近红外光谱仪观察并记录脑组织靶点毁损时的NIRS尤其是优化散射系数()的变化情况。结果:不同温度、不同时间温度点下NIRS出现特征性变化曲线。并建立时间、温度及三维模型。结论:利用NIRS实时活体在位监测猫脑射频神经核团毁损术是科学、可行的,优化散射系数是监测的良好指标,比以往单凭经验的作法更科学、更准确。