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Identification of Radiofrequency Ablation Catheter Parameters That May Induce Intracardiac Steam Pops: Direct Visualization of Elicitation in Reanimated Swine Hearts

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Abstract

Radiofrequency, a common ablation modality, is used clinically to terminate cardiac arrhythmias. With excessive heating, complications sometimes occur when the applied energy generates steam pops, which cause release of energy in the form of tissue and/or air emboli. In this study, we investigated numerous parameters potentially associated with intracardiac steam pops including (1) wattage, (2) catheter tip temperature, (3) catheter irrigation, (4) anatomic site, and (5) repeat ablations at a given site. Using unique Visible Heart® methodologies in reanimated swine hearts, we visualized 539 ablations; steam pops developed in 140 of these ablations. The incidence of steam pops significantly increased for both nonirrigated and irrigated ablations at 40 W (p < 0.005), and for nonirrigated ablations with catheter contact angles perpendicular to the tissue or that encompassed larger surface areas (p < 0.05). To minimize the incidence of steam pops, clinicians performing radiofrequency ablations must consider catheter parameters.

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Abbreviations

RF:

Radiofrequency

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Acknowledgments

The authors thank Mary Knatterud PhD and Monica Mahre for the technical editing and preparation of this manuscript, as well as Ryan Goff PhD, Megan Schmidt PhD, and Lars Mattison for the technical assistance with the project.

Funding

This research was funded by the Institute for Engineering in Medicine at the University of Minnesota and by a research contract from Medtronic (Minneapolis, MN, USA).

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Authors and Affiliations

  1. Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, 420 Delaware St. SE, B172 Mayo, MMC 195, Minneapolis, MN, 55455, USA

    Tinen L. Iles & Paul A. Iaizzo

  2. Department of Biomedical Engineering and Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Stephen G. Quallich

Authors
  1. Tinen L. Iles
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  2. Stephen G. Quallich
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  3. Paul A. Iaizzo
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Correspondence to Paul A. Iaizzo.

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The authors declare that they have no conflict of interest.

Disclosures

Paul Iaizzo has a research contract and consultant appointment with Medtronic. Stephen Quallich is currently employed at Medtronic.

Ethical Approval

Human: No human studies were carried out by the authors for this article. Animal: All institutional and national guidelines for the care and use of laboratory animals were followed and approved by the Institutional Animal Care and Use Committee at the University of Minnesota.

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Associate Editor Ana Barac oversaw the review of this article

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Iles, T.L., Quallich, S.G. & Iaizzo, P.A. Identification of Radiofrequency Ablation Catheter Parameters That May Induce Intracardiac Steam Pops: Direct Visualization of Elicitation in Reanimated Swine Hearts. J. of Cardiovasc. Trans. Res. 12, 250–256 (2019). https://doi.org/10.1007/s12265-018-9844-7

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  • DOI: https://doi.org/10.1007/s12265-018-9844-7

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