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Direct cooling of the catheter tip increases safety for CMR-guided electrophysiological procedures

Please always quote using this URN: urn:nbn:de:bvb:20-opus-134927
  • Background: One of the safety concerns when performing electrophysiological (EP) procedures under magnetic resonance (MR) guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF) field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating. Methods: A two-stepBackground: One of the safety concerns when performing electrophysiological (EP) procedures under magnetic resonance (MR) guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF) field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating. Methods: A two-step approach was chosen. Firstly, tests on passive catheter heating were performed in a 1.5 T Avanto system (Siemens Healthcare Sector, Erlangen, Germany) using a ASTM Phantom in order to determine a possible maximum temperature rise. Secondly, a phantom was designed for simulation of the interface between blood and the vascular wall. The MR-RF induced temperature rise was simulated by catheter tip heating via a standard ablation generator. Power levels from 1 to 6 W were selected. Ablation duration was 120 s with no tip irrigation during the first 60 s and irrigation at rates from 2 ml/min to 35 ml/min for the remaining 60 s (Biotronik Qiona Pump, Berlin, Germany). The temperature was measured with fluoroscopic sensors (Luxtron, Santa Barbara, CA, USA) at a distance of 0 mm, 2 mm, 4 mm, and 6 mm from the catheter tip. Results: A maximum temperature rise of 22.4 degrees C at the catheter tip was documented in the MR scanner. This temperature rise is equivalent to the heating effect of an ablator's power output of 6 W at a contact force of the weight of 90 g (0.883 N). The catheter tip irrigation was able to limit the temperature rise to less than 2 degrees C for the majority of examined power levels, and for all examined power levels the residual temperature rise was less than 8 degrees C. Conclusion: Up to a maximum of 22.4 degrees C, the temperature rise at the tissue surface can be entirely suppressed by using the catheter's own irrigation system. The irrigated tip system can be used to increase MR safety of EP catheters by suppressing the effects of unwanted passive catheter heating due to RF exposure from the MR scanner.show moreshow less

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Author: Theresa Reiter, Daniel Gensler, Oliver Ritter, Ingo Weiss, Wolfgang Geistert, Ralf Kaufmann, Sabine Hoffmeister, Michael T. Friedrich, Stefan Wintzheimer, Markus Düring, Peter Nordbeck, Peter M. Jakob, Mark E. Ladd, Harald H. Quick, Wolfgang R. Bauer
URN:urn:nbn:de:bvb:20-opus-134927
Document Type:Journal article
Faculties:Fakultät für Physik und Astronomie / Physikalisches Institut
Medizinische Fakultät / Medizinische Klinik und Poliklinik I
Language:English
Parent Title (English):Journal of Cardiovascular Magnetic Resonance
Year of Completion:2012
Volume:14
Issue:12
Source:Journal of Cardiovascular Magnetic Resonance 2012 14:12. doi:10.1186/1532-429X-14-12
DOI:https://doi.org/10.1186/1532-429X-14-12
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:EP Procedures; MR guidance; MRI; ablation; catheter tip; contact force; lesion size; model; radiofrequency ablation; safety; temperature; tissue; wires
Release Date:2017/12/17
Licence (German):License LogoCC BY: Creative-Commons-Lizenz: Namensnennung