Mechanism of tissue heating during high intensity focused ultrasound pulmonary vein isolation: implications for atrial fibrillation ablation efficacy and phrenic nerve protection

Journal of Cardiovascular Electrophysiology
Yasuo OkumuraDouglas L Packer

Abstract

The purpose of this study was to examine tissue temperatures around pulmonary veins (PVs) during high intensity focused ultrasound (HIFU) balloon ablation for atrial fibrillation. The thermodynamics and extent of PV and phrenic nerve (PN) heating during HIFU ablation have not been established. Tissue temperatures were recorded from epicardial thermocouples at right superior (RS) PV orifice and PN in eight dogs undergoing 51 RSPV HIFU ablations (40 seconds, 40 W). Maximum tissue temperatures, reflected by 288 recording profiles, were negatively correlated with distance from balloon surface (r =-0.79, P < 0.001). Average maximum RSPV temperature was 56.8 +/- 16.8 degrees C (distance: 6.6 +/- 4.1 mm), resulting in full-thickness, circumferential PV isolation in 7 of 8 animals. Direct local mechanical heating restricted to the focused ultrasound zone showed temperature rise to > or =50 degrees C within 10 seconds to a maximum temperature of 82.6 +/- 8.9 degrees C (n = 31). Apparent conductive heating showed gradual heating patterns (<50 degrees C within 10 seconds) at greater distance. PN temperature at all recording sites was 45.0 +/- 11.3 degrees C (distance: 9.2 +/- 5.0 mm). Intentional PN injury (10 of 51 [19.6%] ablations), oc...Continue Reading

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Citations

Jul 25, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alberto PozzoliOttavio Alfieri
Aug 6, 2009·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·Boris SchmidtKarl-Heinz Kuck
May 18, 2010·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Jeanne ShenRalph J Damiano
Feb 11, 2012·Circulation. Arrhythmia and Electrophysiology·Jacob I LaughnerIgor R Efimov
Nov 11, 2009·Ultrasound in Medicine & Biology·Yegor D SinelnikovArmen P Sarvazyan
Aug 6, 2009·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Jeanne ShenRalph J Damiano
Jun 9, 2009·Journal of Cardiovascular Electrophysiology·Yasuo OkumuraDouglas L Packer
Jun 17, 2008·Journal of Cardiovascular Electrophysiology·Conor D Barrett, Andrea Natale
Jun 17, 2011·Journal of Cardiovascular Electrophysiology·Jacob S KoruthAndre D'Avila
Jul 24, 2012·Pacing and Clinical Electrophysiology : PACE·T Jared Bunch, John D Day
Oct 14, 2009·Circulation·J David Burkhardt, Andrea Natale
Dec 24, 2014·Circulation. Arrhythmia and Electrophysiology·Mitsuru TakamiDouglas L Packer
May 11, 2016·Circulation. Arrhythmia and Electrophysiology·David E Haines

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