Document Detail


Chronic performance of a novel radiofrequency ablation device on the beating heart: Limitations of conduction delay to assess transmurality.
MedLine Citation:
PMID:  22305553     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The creation of consistently transmural lesions with epicardial ablation on the beating heart has represented a significant challenge for current technology. This study examined the chronic performance of the AtriCure Coolrail device (AtriCure Inc, West Chester, Ohio), an internally cooled, bipolar radiofrequency ablation device designed for off-pump epicardial ablation. The study also examined the reliability of using acute intraoperative conduction delay to evaluate lesion integrity.
METHODS: Seven swine underwent median sternotomy. The right atrial appendage and inferior vena cava were isolated with a bipolar radiofrequency clamp. Linear ablation lines were created between these structures with the AtriCure Coolrail. Paced activation maps were recorded with epicardial patch electrodes acutely before and after ablation and after keeping the animals alive for 4 weeks. The conduction time across the linear ablation was calculated from these maps. The lesions were histologically evaluated with trichrome staining.
RESULTS: Only 76% of cross-sections of Coolrail lesions were transmural, and only 1 of 12 ablation lines was transmural in every cross-section examined. Mapping data were available in 5 of the animals. Significant conduction delay was present after the creation of each line of ablation acutely; however, after 4 weeks, conduction time returned to preablation values, demonstrating lack of transmurality.
CONCLUSIONS: The AtriCure Coolrail failed to reliably create transmural lesions. Although the Coolrail was able to create acute conduction delay, its failure to transmurally ablate the atrial myocardium left gaps along the length of the lesion, which resulted in neither chronic conduction block nor delay across any line of ablation.
Authors:
Anson M Lee; Abdulhameed Aziz; Kal L Clark; Richard B Schuessler; Ralph J Damiano
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-02-02
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  144     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-17     Completed Date:  2012-11-30     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  859-65     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Atrial Appendage / pathology,  physiopathology,  surgery*
Cardiac Pacing, Artificial
Cardiac Surgical Procedures / adverse effects,  instrumentation*
Catheter Ablation / adverse effects,  instrumentation*
Electrophysiologic Techniques, Cardiac
Equipment Design
Heart Conduction System / pathology,  physiopathology,  surgery*
Materials Testing
Models, Animal
Sternotomy
Swine
Swine, Miniature
Time Factors
Vena Cava, Inferior / pathology,  physiopathology,  surgery*
Grant Support
ID/Acronym/Agency:
5R01HL32257/HL/NHLBI NIH HHS; R01 HL032257/HL/NHLBI NIH HHS; R01 HL085113/HL/NHLBI NIH HHS; T32 HL007776/HL/NHLBI NIH HHS; T32 HL085113/HL/NHLBI NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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