Impact of Lowering Irrigation Flow Rate on Atrial Lesion Formation in Thin Atrial Tissue: Preliminary Observations From Experimental and Clinical Studies

JACC. Clinical Electrophysiology
Saurabh KumarGregory Michaud

Abstract

The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation. Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter a...Continue Reading

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Citations

Jun 19, 2018·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Francis J HaHan S Lim
Dec 13, 2019·Journal of Cardiovascular Electrophysiology·Amneet Sandhu, Duy T Nguyen
May 12, 2020·Pacing and Clinical Electrophysiology : PACE·Ruhong JiangChenyang Jiang
Apr 24, 2020·Journal of Cardiovascular Electrophysiology·Fabrizio R AssisHarikrishna Tandri
Oct 4, 2019·Journal of Cardiovascular Electrophysiology·Travis Richardson, Gregory F Michaud
Jul 6, 2020·Journal of Cardiovascular Electrophysiology·Jie QiuGuangzhi Chen
Mar 24, 2018·Journal of Cardiovascular Electrophysiology·Rahul G MuthalalyBruce A Koplan
Apr 11, 2018·Arrhythmia & Electrophysiology Review·Jorge RomeroLuigi Di Biase
Jan 24, 2021·Journal of Cardiovascular Electrophysiology·Oluwaseun AdeolaGregory Michaud
Mar 12, 2021·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Jim O'BrienDhiraj Gupta
Jul 15, 2021·Journal of Cardiovascular Electrophysiology·John-Ross D ClarkeDaniel J Friedman
Aug 2, 2021·Progress in Cardiovascular Diseases·Robert J Knotts, Chirag R Barbhaiya
Oct 26, 2021·Frontiers in Cardiovascular Medicine·Je-Wook ParkHui-Nam Pak
Dec 3, 2021·Journal of Cardiovascular Electrophysiology·Timothy CampbellSaurabh Kumar

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