Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous proc
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Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous procedural setting Francesco Matteucci 1,2 & Bart Maesen 1,2 & Carlo De Asmundis 3 & Elham Bidar 1,2 & Gianmarco Parise 1,2 & Jos G. Maessen 1,2 & Mark La Meir 1,3 & Sandro Gelsomino 1,2,3 Received: 28 June 2020 / Accepted: 12 August 2020 # The Author(s) 2020
Abstract Purpose To make an in vitro evaluation of the lesion size and depth produced in two different sets of radio frequency energy bipolar delivery: simultaneous biparietal bipolar (SBB) and simultaneous uniparietal bipolar (SUB). Methods Two separate prototypes have been built for our purpose: one to be used in SBB mode and the other to be used SUB mode. Forty left atrium samples were taken from the hearts of freshly slaughtered pigs. They were ablated into a simulator ABLABOX, where blood flow, temperature, and contact force were controlled. After being sliced into a cryotome, the samples were digitalized by a flatbed scanner, and the images were analyzed by a computer morphometric software. Results Transmural lesions were achieved in 18/20 samples (90%) in SBB, while SUB showed transmurality in 9/20 samples (45%). Overall maximum diameter (DMAX) resulted larger in SUB than in SBB (2.43 ± 0.30 mm, 1.62 ± 0.14 mm, respectively; p < 0.05): Moreover, maximum epicardial and endocardial diameters (DEPI and DENDO, respectively) were wider in SUB group than SBB group (2.28 ± 0.30 mm, 2.26 ± 0.40 and 1.60 ± 0.14 mm, 1.59 ± 0.15 mm, respectively; p < 0.05). We observed the same tendency in lesion depth: The total area and volume (ATOT and VTOT) were broader in SUB group than in SBB one (581.01 ± 65.38 mm/mm2, 58.10 ± 6.53 mm/mm3 and 521.97 ± 73.05 mm/mm2, 52.19 ± 7.30 mm/mm3. respectively; p < 0.05). Conclusions In contrast with the smaller lesion sizes, the biparietal bipolar group showed a higher transmurality rate. These findings may suggest a better drive of the energy flow when compared with SUB lesions. Keywords Biparietal bipolar ablation . Bipolar radio frequency energy . Bipolar prototype . In vitro bipolar ablation
1 Introduction Hybrid ablation (HA) exploits the concomitant effect of epicardial and endocardial procedures performed together by a surgeon and an electrophysiologist. It combines epicardial ablation performed by bilateral thoracotomy to a standard transcatheter endocardial ablation. Apart from joining the advantages of the two procedures, this technique allows the electrophysiologist to test the ablation, to add touch-up ablation if
* Francesco Matteucci [email protected] 1
Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
2
Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
3
Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
necessary and to reach part of the heart that cannot be ablated by the surgeons [1]. Radio frequency (RF)
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