Peak Tissue Temperature Research Articles

In vivo tissue temperatureduring lesion size index-guided 50W ablation versus 30W ablation: A porcine study.

Neither the actual in vivo tissue temperatures reached with lesion size index (LSI)-guided high-power short-duration (HPSD) ablation for atrial fibrillation nor the safety profile has been elucidated. We conducted a porcine study (n = 7) in which, after right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We compared tissue temperatures reached during 50 W-HPSD ablation with those reached during standard (30 W) ablation, both targeting anLSIof 5.0 (5-15 g contact force). Tmax (maximum tissue temperaturewhen the thermocouple was located ≤5 mm from the catheter tip)reached during HPSD ablation was modestly higher than that reached during standard ablation (58.0 ± 10.1°C vs. 53.6 ± 9.2°C; p = .14) and peak tissue temperature correlated inversely with the distance between the catheter tip and the thermocouple, regardless of the power settings (HPSD: r = -0.63; standard: r = -0.66). Lethal temperature (≥50°C) reached 6.3 ± 1.8 s and 16.9 ± 16.1 s after the start of HPSD and standard ablation, respectively (p = .002), and it was best predicted at a catheter tip-to-thermocouple distance cut point of 2.8 and 5.3 mm, respectively. All lesions produced by HPSD ablation and by standard ablation were transmural. There was no difference between HPSD ablation and standard ablation in the esophageal injury rate (70% vs. 75%, p = .81), but the maximum distance from the esophageal adventitia to the injury site tended to be shorter (0.94 ± 0.29 mm vs. 1.40 ± 0.57 mm, respectively; p = .09). Actual tissue temperatures reached with LSI-guided HPSD ablation appear to be modestly higher, with a shorter distance between the catheter tip and thermocouple achieving lethal temperature, than those reached with standard ablation. HPSD ablation lasting <6 s may help minimize lethal thermal injury to the esophagus lying at a close distance.

Bioheat Model of Spinal Column Heating During High-Density Spinal Cord Stimulation

IntroductionHigh-density (HD) spinal cord stimulation (SCS) delivers higher charge per time by increasing frequency and/or pulse duration, thus increasing stimulation energy. Previously, through phantom studies and computational modeling, we demonstrated that stimulation energy drives spinal tissue heating during kHz SCS. In this study, we predicted temperature increases in the spinal cord by HD SCS, the first step in considering the potential impact of heating on clinical outcomes. Materials and MethodsWe adapted a high-resolution computer-aided design–derived spinal cord model, both with and without a lead encapsulation layer, and applied bioheat transfer finite element method multiphysics to predict temperature increases during SCS. We simulated HD SCS using a commercial SCS lead (eight contacts) with clinically relevant intensities (voltage-controlled: 0.5–7 Vrms) and electrode configuration (proximal bipolar, distal bipolar, guarded tripolar [+−+], and guarded quadripolar [+−−+]). Results were compared with the conventional and 10-kHz SCS (current-controlled). ResultsHD SCS waveform energy (reflecting charge per second) governs joule heating in the spinal tissues, increasing temperature supralinearly with stimulation root mean square. Electrode configuration and tissue properties (an encapsulation layer) influence peak tissue temperature increase—but in a manner distinct for voltage-controlled (HD SCS) compared with current-controlled (conventional/10-kHz SCS) stimulation. Therefore, depending on conditions, HD SCS could produce heating greater than that of 10-kHz SCS. For example, with an encapsulation layer, using guarded tripolar configuration (500-Hz, 250-μs pulse width, 5-Vpeak HD SCS), the peak temperature increases were 0.36 °C at the spinal cord and 1.78 °C in the epidural space. ConclusionsAs a direct consequence of the higher charge, HD SCS increases tissue heating; voltage-controlled stimulation introduces special dependencies on electrode configuration and lead encapsulation (reflected in impedance). If validated with an in vivo measurement as a possible mechanism of action of SCS, bioheat models of HD SCS serve as tools for programming optimization.

Absence of acute ocular damage in humans after prolonged exposure to intense RF EMF

The eye is considered to be a critical organ when determining safety standards for radio frequency (RF) radiation. Experimental data obtained using animals showed that RF heating of the eye, particularly over a specific threshold, can induce cataracts. During the treatment of cancer in the head and neck by hyperthermia, the eyes receive a considerable dose of RF radiation due to stray radiation from the prolonged (60 min) and intense exposure at 434 MHz of this region. In the current study, we verified the exposure guidelines for humans by determining the association between the electromagnetic and thermal dose in the eyes with the reported ocular effects. We performed a simulation study to retrospectively assess the specific absorption rate (SAR) and temperature increase in the eyes of 16 selected patients (encompassing a total of 74 treatment sessions) whose treatment involved high power delivery as well as a minimal distance between the tumor site and the eye. Our results show that the basic restrictions on the peak 10 g spatial-averaged SAR (10 W kg−1) and peak tissue temperature increase (1 °C) are exceeded by up to 10.4 and 4.6 times, on average, and by at least 6.2 and 1.8 times when considering the lower limit of the 95% confidence interval. Evaluation of the acute effects according to patients’ feedback (all patients), the common toxicity criteria scores (all patients) and an ophthalmology investigation (one patient with the highest exposure) revealed no indication of any serious acute ocular effect, even though the eyes were exposed to high electromagnetic fields, leading to a high thermal dose. We also found that, although there is a strong correlation (R2 = 0.88) between the predicted induced SAR and temperature in the eye, there are large uncertainties regarding the temperature-SAR relationship. Given this large uncertainty (129%) compared with the uncertainty of 3D temperature simulations (61%), we recommend using temperature simulations as a dosimetric measure in electromagnetic exposure risk assessments.

Radiofrequency lesioning through deep brain stimulation electrodes: A pilot study of lesion geometry and temperature characteristics

Deep brain stimulation (DBS) electrodes have been used effectively to perform radiofrequency lesions in the brain. This study aimed to characterize lesion geometry and peak tissue temperature achieved when lesioning through DBS electrodes. Fresh bovine liver was chosen for a medium as the tissue reliably changes color between 45 and 50°C. Medtronic 3387 DBS electrodes (Medtronic Sofamor Danek, Inc., Memphis, TN, USA) and the Cosman G4 Radiofrequency Generator (Cosman Medical, Inc., Burlington, MA, USA) were used for lesioning. Bipolar lesions were created at currents between 25mA and 100mA for 60–120seconds. Peak tissue temperature was monitored with Cosman disposable cordotomy electrode (LCED; Cosman Medical Inc.) and recorded. Photographic analysis of the lesions was performed. Tissue impedance ranged between 800–900Ohms, and tissue temperature was maintained at 20°C. With lesions at 25mA for up to 120seconds, maximal tissue temperature achieved was 36°C. This correlated with no visible lesions. At 50mA, maximal tissue temperature exceeded 100°C, which was associated with tissue charring. Lesions created at 35mA and 40mA led to an increase in tissue temperature of 63°C and 75°C, respectively. Lesion size was highly reproducible, increasing from 4.5mm×7mm at 35mA, to 6mm×7.5mm at 50mA. Preliminary analysis suggests that caution should be exerted in using lesion amplitudes exceeding 40mA (at 800Ohms), as peak tissue temperatures in vivo could exceed 100°C. Further in vivo experiments with imaging correlates are needed to further test the safety of this technique.

Thermal Tissue Damage Model Analyzed for Different Whole‐Body SAR and Scan Durations for Standard MR Body Coils

This article investigates the safety of radiofrequency induced local thermal hotspots within a 1.5T body coil by assessing the transient local peak temperatures as a function of exposure level and local thermoregulation in four anatomical human models in different Z-positions. To quantize the effective thermal stress of the tissues, the thermal dose model cumulative equivalent minutes at 43°C was employed, allowing the prediction of thermal tissue damage risk and the identification of potentially hazardous MR scan-scenarios. The numerical results were validated by B1 (+) - and skin temperature measurements. At continuous 4 W/kg whole-body exposure, peak tissue temperatures of up to 42.8°C were computed for the thermoregulated model (60°C in nonregulated case). When applying cumulative equivalent minutes at 43°C damage thresholds of 15 min (muscle, skin, fat, and bone) and 2 min (other), possible tissue damage cannot be excluded after 25 min for the thermoregulated model (4 min in nonregulated). The results are found to be consistent with the history of safe use in MR scanning, but not with current safety guidelines. For future safety concepts, we suggest to use thermal dose models instead of temperatures or SAR. Special safety concerns for patients with impaired thermoregulation (e.g., the elderly, diabetics) should be addressed.

Towards the development of latent heat storage electrodes for electroporation-based therapies

Phase change materials (PCMs) capable of storing a large amount of heat upon transitioning from the solid-to-liquid state have been widely used in the electronics and construction industries for mitigating temperature development. Here, we show that they are also beneficial for reducing the peak tissue temperature during electroporation-based therapies. A numerical model is developed of irreversible electroporation (IRE) performed with hollow needle electrodes filled with a PCM. Results indicate that this electrode design can be utilized to achieve large ablation volumes while reducing the probability for thermal damage.

In vitro infrared thermography assessment of temperature peaks during the intra-oral welding of titanium abutments

Control of heat dissipation and transmission to the peri-implant area during intra-oral welding is very important to limit potential damage to the surrounding tissue. The aim of this in vitro study was to assess, by means of thermal infrared imaging, the tissue temperature peaks associated with the thermal propagation pathway through the implants, the abutments and the walls of the slot of the scaffold, generated during the welding process, in three different implant systems. An in vitro polyurethane mandible model was prepared with a 7.0mm v-shape slot. Effects on the maximum temperature by a single welding procedure were studied using different power supplies and abutments. A total of 36 welding procedures were tested on three different implant systems. The lowest peak temperature along the walls of the 7.0mm v-shaped groove (31.6±2°C) was assessed in the specimens irrigated with sterile saline solution. The highest peak temperature (42.8±2°C) was assessed in the samples with a contemporaneous power overflow and premature pincers removal. The results of our study suggest that the procedures used until now appear to be effective to avoid thermal bone injuries. The peak tissue temperature of the in vitro model did not surpass the threshold limits above which tissue injury could occur.

SAR versus Sinc: What is the appropriate RF exposure metric in the range 1–10 GHz? Part I: Using planar body models

This is the first of two articles addressing the most appropriate crossover frequency at which incident power flux density (S(inc)) replaces the spatial peak value of the specific energy absorption rate (SAR) averaged over 1 or 10 g (i.e., peak 1 or 10 g SAR) as the basic restriction for protecting against radiofrequency (RF) heating effects in the 1-10 GHz range. Our general approach has been to compare the degree of correlation between these basic restrictions and the peak induced tissue temperature rise (DeltaT) for a representative range of population/exposure scenarios. In this article we particularly address the effect of human population diversity in the thickness of body tissue layers at eight different sites of the body. We used a Monte Carlo approach to specify 32000 models (400 models for each of 8 body sites for 10 frequencies) which were representative of tissue thicknesses for age (18-74 years) and sex at the eight body sites. Histogram distributions of S(inc) and peak 1 and 10 g SAR corresponding to a peak 1 degrees C temperature rise were obtained from RF and thermal analyses of 1D multiplanar models exposed to a normally incident plane wave ranging from 1 to 10 GHz in thermo-neutral environmental conditions. Examination of the distribution spread of the histograms indicated that peak SAR was a better predictor of peak tissue temperature rise across the entire 1-10 GHz frequency range than S(inc), as indicated by the smaller spread in its histogram distributions, and that peak 10 g SAR was a slightly better predictor than peak 1 g SAR. However, this result must be weighed against partly conflicting indications from complex body modeling in the second article of this series, which incorporates near-field effects and the influence of complex body geometries.

Esophageal Luminal Temperature Measurement Underestimates Esophageal Tissue Temperature During Radiofrequency Ablation Within the Canine Left Atrium: Comparison Between 8 mm Tip and Open Irrigation Catheters

Evaluation of luminal temperature during left atrial ablation is used clinically; however, luminal temperature does not necessarily reflect temperature within the esophageal wall and poses a risk of atrioesophageal fistula. This animal study evaluates luminal esophageal temperature and its relation to the temperature of the external esophageal tissue during left atrial lesions using the 8 mm solid tip and the open irrigated tip catheters (OIC). A thermocouple was secured to the external surface of the esophagus at the level of the left atrium of the dogs. Luminal esophageal temperature was measured using a standard temperature probe. In four randomized dogs, lesions were placed using an 8 mm solid tip ablation catheter. In six randomized dogs, lesions were placed using the 3.5 mm OIC. The average peak esophageal tissue temperature when using the OIC was significantly higher than that of the 8 mm tip catheter (88.6 degrees C +/- 15.0 degrees C vs. 62.3 degrees C +/- 12.5 degrees C, P < 0.05). Both OIC and 8 mm tip catheter had significantly higher peak tissue temperatures than luminal temperatures (OIC: 88.6 degrees C +/- 15.0 degrees C vs 39.7 degrees C +/- 0.82 degrees C, P < 0.05) (8 mm: 62.3 degrees C +/- 12.5 degrees C vs 39.0 +/- 0.5 degrees C, P < 0.05). Both catheters achieved peak temperatures faster in the tissue as compared to the lumen of the esophagus, although the tissue temperature peaked significantly faster for the OIC (OIC: 25 seconds vs 90 seconds, P < 0.05) (8 mm: 63 seconds vs 105 seconds, P < 0.05). Despite the significant difference in actual tissue temperatures, no significant difference was observed in luminal temperatures between the OIC and 8 mm tip catheter.

Application of a Granular Mineral-Based Hemostatic Agent (QuikClot) to Reduce Blood Loss After Grade V Liver Injury in Swine

Uncontrolled hemorrhage is a leading cause of death in cases of trauma. Many products currently are under development to control traumatic bleeding. One such Food and Drug Administration (FDA)-approved product is QuikClot. This study determined the efficacy of QuikClot, a hemostatic agent, in reducing blood loss and mortality in a standardized model of severe liver injury as well as the consequences of its use. Swine received either QuikClot or gauze treatment after induction of grade V liver injuries. Hemostasis, blood loss, resuscitation volume, 60-minute survival, and peak tissue temperatures were measured. Hemostasis was improved with QuikClot (p < 0.05), and resuscitation volume was consequently reduced (p < 0.05). Posttreatment blood loss was reduced (p < 0.01) with QuikClot (1,397 mL), as compared with gauze (5,338 mL). The survival rate was seven of eight in the QuikClot group and one of eight in the gauze group (p < 0.01). Peak temperature at the tissue interface was increased (p < 0.01) with QuikClot (93.3 +/- 10.5 degrees C), as compared with gauze (37.5 +/- 6.5 degrees C). QuikClot use was associated with both macro- and microscopic tissue damage caused by the exothermic reaction. QuikClot provides hemostasis and decreased mortality in this model of severe liver injury. The beneficial aspects of QuikClot treatment must, however, be balanced against the tissue-damaging effects of the exothermic reaction.

Physiological consequences of bipolar radiofrequency energy on the atria and pulmonary veins: a chronic animal study

Background Alternative energy sources have been proposed for the transvenous and surgical treatment of atrial fibrillation. This study examined the physiologic consequences of a novel energy source, bipolar radiofrequency energy, in a chronic animal model in order to determine its ability to produce transmural lesions on the beating heart. Methods Five dogs underwent baseline pacing from the following target areas: right and left atrial appendage, superior and inferior vena cavae, and right and left pulmonary veins. A cuff of atrial myocardium, proximal to the target tissue was clamped and ablated between the arms of the bipolar radiofrequency energy device. Tissue conductance was used as a transmural indicator. After ablation, the pacing protocol was repeated. Baseline and postablation pulmonary vein flows were measured. Animals were survived for 30 days, and permanent electrical isolation was evaluated by pacing, epicardial mapping, and histology. Results Mean ablation time was 5.0 ± 1.8 seconds and mean peak tissue temperature was 46.7°C ± 2.8°C. All lesions (30/30) acutely and permanently isolated atrial tissue. There was no change in pulmonary vein flow. Mapping studies with pacing of atrial tissue on both sides of the lesion confirmed isolation. Histology demonstrated that all lesions were linear, continuous, and transmural with no thrombus formation or stenosis. Conclusions Bipolar radiofrequency energy rapidly produced permanent transmural linear lesions on the beating heart. Measurement of tissue conductance reliably predicted transmural lesions. This new technology may enable the development of a less invasive, surgical approach to atrial fibrillation.

TEMPERATURE RISE IN DEEP MUSCLE TISSUE DURING A THREE-HOUR THERAPEUTIC HEAT WRAP APPLICATION

Heat modalities are used in physical therapy and athletic training settings to relieve pain, promote healing, and facilitate motion, however temperatures rapidly return to baseline once the modality is removed. A therapeutic heat wrap that provides a continuous source of heat for up to 8 hours is now commercially available. PURPOSE To assess deep muscle temperature of the gastrocnemius during a 3-hour period of wearing a therapeutic heat wrap. METHODS 11 volunteers (8 male, 3 female, age 29.6 ± 7.8) participated in this study. A flexible implantable thermocouple probe was inserted into the medial head of the gastrocnemius muscle to a 2 cm depth. After exposing the wrap to the atmosphere for 30 min to activate the heat discs, it was secured to the calf, and centered over the probe site. Muscle tissue temperature was recorded at baseline and every 30 sec for three hours while the subject remained at rest. A repeated-measures ANOVA (P < 0.05) was used to analyze the temperatures at baseline and every 10 min for 3 hrs post wrap application. RESULTS Intramuscular temperature increased significantly over time. Post hoc analyses revealed that temperature was elevated from baseline (34.68 ± 1.02°C) by 0.98°C 20-minutes post application (35.66 ± 0.65°C), and remained significantly elevated for the remainder of the 3-hour period. Intramuscular temperature continued to rise significantly, and was elevated from baseline by 1.69°C (36.37 ± 0.63°C) at 60 min, 1.95°C (36.63 ± 0.95°C) at 120 min, and 2.20°C (36.88 ± 1.07°C) at 180 min post application. CONCLUSION Application of a therapeutic heat wrap resulted in significantly elevated deep muscle temperature 20 min post application. Tissue temperature continued to rise significantly, and achieved a peak tissue temperature elevation of 2.20°C three-hours post application. The wrap is a potential alternative heat modality when a prolonged heating effect is desired. Funded by the Procter & Gamble Company

Linear lesions in myocardium created by Nd:YAG laser using diffusing optical fibers: in vitro and in vivo results.

Linear lesions may be necessary for successful catheter ablation of cardiac arrhythmias such as atrial fibrillation. This study uses laser energy delivered through diffusing optical fibers as an alternative to radiofrequency energy for the creation of linear lesions in cardiac tissue in a single application. Samples of canine myocardium were placed in a heated, circulating saline bath and irradiated with a 1.06-microm, continuous-wave Nd:YAG laser during in vitro studies. Laser ablation was then performed in vivo on the epicardial surface of the right ventricle during an open-chest procedure by using similar ablation parameters. Laser energy was delivered to the tissue by being diffused radially through flexible optical fiber tips oriented parallel to the tissue surface. Histology and temperature measurements verified transmurality, continuity, and linearity of the lesions. Peak tissue temperatures measured in vitro remained low (51 +/- 1 degrees C at the endocardial surface, 61 +/- 6 degrees C in the mid-myocardium, and 55 +/- 6 degrees C at the epicardial surface) with no evidence of tissue charring or vaporization. Lesion dimensions produced in vitro and in vivo were similar (depth, 6 mm; width, 8-10 mm; length, 16-22 mm), demonstrating that tissue perfusion in vivo did not significantly alter the heating. Long linear lesions, necessary for duplication of the surgical maze procedure during catheter ablation of atrial fibrillation, may be created by using laser radiation delivered through flexible diffusing optical fiber tips. Further development of steerable catheters for endocardial atrial ablation and studies correlating thermal damage zones with electrophysiologic indicators of irreversible conduction block are warranted.