Abstract
Background: Radiofrequency ablation (RFA) effectively treats arrhythmia. Steam pop (SP) is a dangerous complication of RFA, which can lead to pericardial tamponade or even death.Objective: This study aimed to explore the electro-characteristics of myocardial pouches, and the relationship between SP, pouch, and impedance.Methods: Swine myocardium was divided into the pouch group and smooth myocardium group. Continuous RFA at 50 W was applied. The initial impedance reduction within the first 3 s of ablation and the time from the start of ablation to SP were recorded. After enabling the delta impedance cutoff function, RFA was performed at different percentage of delta impedance (PDI) cutoff thresholds.Results: The impedance was higher for the pouch myocardium compared to the smooth myocardium (123.22 ± 8.63 Ω and 95.75 ± 4.75 Ω, respectively; p < 0.001). The RFA duration before SPs was shorter in the pouch group compared to the smooth myocardium group [9 s (interquartile range, IQR: 6.25–13 s) and 33 s (IQR: 26.25–40.75 s), respectively; p < 0.001]. Within the first 3 s of RFA, impedance reduction (24.65 ± 6.57 Ω and 12.78 ± 3.35 Ω, respectively; p < 0.001) and PDI [19.18% (IQR: 16.39–24.20%) and 12.96% (IQR: 11.17–14.39%), respectively; p < 0.001] were greater in the pouch group compared to the smooth myocardium group. A PDI of 15% and delta time of 3 s effectively reduced the frequency of SPs without seriously affecting RFA use.Conclusion: SPs occur more frequently in the pouch area during RFA. Appropriate delta impedance cutoff settings (PDI: 15%; delta time: 3 s) can reduce the frequency of SPs and improve the RFA safety.
Highlights
Radiofrequency ablation (RFA) is an effective treatment for patients with arrhythmia (Hindricks et al, 2021)
RFA duration before the steam pop (SP) was significantly shorter in the pouch group compared to the smooth myocardium group [9 s (IQR: 6.25–13 s) and 33 s (IQR: 26.25–40.75 s), respectively; p < 0.001; Figure 3A]
The initial impedance was significantly higher in the pouch group compared to the smooth myocardium group (123.22 ± 8.63 Ω and 95.75 ± 4.75 Ω, respectively; p < 0.001; Figure 3B)
Summary
Radiofrequency ablation (RFA) is an effective treatment for patients with arrhythmia (Hindricks et al, 2021). As the tissue temperatures rise, steam is formed within the myocardium, leading to a steam pop (SP). SPs are relatively infrequent (0.1–1.5%) but are a potentially severe complication of RFA; SPs may result in myocardial wall disruption and increased risk for cardiac perforation, pericardial tamponade, embolic stroke, and even death (Seiler et al, 2008; Tokuda et al, 2011). It is difficult to achieve the optimal balance between sufficient energy to penetrate deep myocardial tissues and avoiding excessive heat and SPs. it will be useful to develop technology that prevents this potentially lifethreatening complication (Kondo et al, 2017; Viles-Gonzalez et al, 2017). Steam pop (SP) is a dangerous complication of RFA, which can lead to pericardial tamponade or even death
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