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Establishing safe working parameters for radio frequency catheterization along with acoustic sensing

Session Poster Session 2

Speaker Wadih El Khoury

Event : ESC Congress 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Catheter Ablation of Arrhythmias
  • Session type : Poster Session

Authors : M Refaat (Beirut,LB), W El Khoury (Beirut,LB), N Rmeity (Beirut,LB), A Mahmasani (Beirut,LB), J Al Aaraj (Beirut,LB), M Akiki (Beirut,LB), A Gebran (Beirut,LB), R Abbas (Beirut,LB), M Hajjar (Beirut,LB), G Oweis (Beirut,LB)

M. Refaat1 , W. El Khoury2 , N. Rmeity3 , A. Mahmasani3 , J. Al Aaraj3 , M. Akiki3 , A. Gebran2 , R. Abbas2 , M. Hajjar2 , G. Oweis3 , 1American University of Beirut Medical Center, Department of Cardiology - Beirut - Lebanon , 2American University of Beirut AUB, Faculty of Medicine - Beirut - Lebanon , 3American University of Beirut AUB, Department of Mechanical Engineering - Beirut - Lebanon ,

Catheter Ablation of Arrhythmias

European Heart Journal ( 2019 ) 40 ( Supplement ), 1156

Background: Studies comparing angles of application in Radio Frequency (RF) catheter ablation other than 0 and 90 degrees are absent from the literature. Likewise, using acoustics to predict steam pop occurrences and prevent a catastrophic rupture of the myocardium has not been examined previously.

Purpose: Evaluate the effect of various parameters on the ablated volume and the probability of creating a boiling pop.

Methods: A low-cost testing and educational platform to work with generic RF catheters was set up. The in-vitro system allows controlling the blood flow surrogate over the cardiac tissue, the catheter contact force, electric power, and ablation time. Acoustic transducers have been employed with the setup to detect preliminary acoustic signals.

Results: Obtained results show a positive correlation between variations of the ablated surface geometry and power intensity changes. Generated figures provide percentages of a boiling pops for any given set of parameters fig1 (Top left: Probability of popping vs power and time). The probability of a boiling pop occurring increased if the ovine specimen is non-irrigated. The ratio of the burn correlates with the power and the angle of the catheter (30°, 45°, 60°, and 90°). However, the probability of the popping mostly depends on the power fig1 (Top right: Burn ratio vs power for 30°, 45°, 60°, and 90°) and fig1 (Bottom right: Cross sectional view of the corresponding lesions -same scale used for all images). Benign precursory bubbles detected by acoustics preceded the occurrence of catastrophic boiling pops fig1 (Bottom left: Acoustic signal showing a precursory pop before the major cavitation).

Conclusion: The established parameters for power intensity and exposure time should be respected to maintain a safe procedure. Acoustics can be further implemented to provide a warning for electrophysiologists before the occurrence of a boiling pop.

Figure 1

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