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Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch
BACKGROUND: A subeustachian pouch (SEP) often hinders the completion of a cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL) and sometimes causes steam‐pops during a power‐controlled ablation. We hypothesized that real‐time bull's‐eye monitoring of the catheter surface tempera...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745479/ https://www.ncbi.nlm.nih.gov/pubmed/36524041 http://dx.doi.org/10.1002/joa3.12793 |
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author | Hirata, Moyuru Nagashima, Koichi Watanabe, Ryuta Wakamatsu, Yuji Otsuka, Naoto Hayashida, Satoshi Hirata, Shu Sawada, Masanaru Kurokawa, Sayaka Okumura, Yasuo |
author_facet | Hirata, Moyuru Nagashima, Koichi Watanabe, Ryuta Wakamatsu, Yuji Otsuka, Naoto Hayashida, Satoshi Hirata, Shu Sawada, Masanaru Kurokawa, Sayaka Okumura, Yasuo |
author_sort | Hirata, Moyuru |
collection | PubMed |
description | BACKGROUND: A subeustachian pouch (SEP) often hinders the completion of a cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL) and sometimes causes steam‐pops during a power‐controlled ablation. We hypothesized that real‐time bull's‐eye monitoring of the catheter surface temperature might be useful to locate the SEP where the temperature can rise rapidly, and a temperature‐controlled ablation might avoid steam pops. This study aimed to demonstrate this hypothesis. METHODS: A temperature‐controlled CTI ablation with a QDOT MICRO™ catheter (n = 10) and a conventional power‐controlled CTI ablation (n = 10) were performed with an output power of 35 W. During the RF application, the bull's eye monitor for monitoring the catheter surface temperatures was assessed. A “red‐bull sign” was defined as an entire red‐colored bull's‐eye monitor, indicating that the catheter‐tip temperature of all 6 thermocouples rose rapidly over 47°C. RESULTS: In a total of 115 lesions (12 ± 3 per patient), a “red‐bull sign” was observed in 39 (33.9%) lesions where the RF output was reduced to 26 ± 8 W. All 39 “red‐bull sign” lesions corresponded to the location of the SEP as delineated by ICE before the ablation. The red‐bull sign accurately indicated the presence of a SEP with a sensitivity of 84.7% and specificity of 100%. Bidirectional block of the CTI was completed in all patients in either catheter group without any steam‐pops. CONCLUSION: Real‐time surface temperature monitoring and a red‐bull sign might be useful to detect the SEP. A temperature‐controlled CTI ablation with the QDOT MICRO catheter might be safe for avoiding steam pops. |
format | Online Article Text |
id | pubmed-9745479 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97454792022-12-14 Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch Hirata, Moyuru Nagashima, Koichi Watanabe, Ryuta Wakamatsu, Yuji Otsuka, Naoto Hayashida, Satoshi Hirata, Shu Sawada, Masanaru Kurokawa, Sayaka Okumura, Yasuo J Arrhythm Original Articles BACKGROUND: A subeustachian pouch (SEP) often hinders the completion of a cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL) and sometimes causes steam‐pops during a power‐controlled ablation. We hypothesized that real‐time bull's‐eye monitoring of the catheter surface temperature might be useful to locate the SEP where the temperature can rise rapidly, and a temperature‐controlled ablation might avoid steam pops. This study aimed to demonstrate this hypothesis. METHODS: A temperature‐controlled CTI ablation with a QDOT MICRO™ catheter (n = 10) and a conventional power‐controlled CTI ablation (n = 10) were performed with an output power of 35 W. During the RF application, the bull's eye monitor for monitoring the catheter surface temperatures was assessed. A “red‐bull sign” was defined as an entire red‐colored bull's‐eye monitor, indicating that the catheter‐tip temperature of all 6 thermocouples rose rapidly over 47°C. RESULTS: In a total of 115 lesions (12 ± 3 per patient), a “red‐bull sign” was observed in 39 (33.9%) lesions where the RF output was reduced to 26 ± 8 W. All 39 “red‐bull sign” lesions corresponded to the location of the SEP as delineated by ICE before the ablation. The red‐bull sign accurately indicated the presence of a SEP with a sensitivity of 84.7% and specificity of 100%. Bidirectional block of the CTI was completed in all patients in either catheter group without any steam‐pops. CONCLUSION: Real‐time surface temperature monitoring and a red‐bull sign might be useful to detect the SEP. A temperature‐controlled CTI ablation with the QDOT MICRO catheter might be safe for avoiding steam pops. John Wiley and Sons Inc. 2022-11-07 /pmc/articles/PMC9745479/ /pubmed/36524041 http://dx.doi.org/10.1002/joa3.12793 Text en © 2022 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Hirata, Moyuru Nagashima, Koichi Watanabe, Ryuta Wakamatsu, Yuji Otsuka, Naoto Hayashida, Satoshi Hirata, Shu Sawada, Masanaru Kurokawa, Sayaka Okumura, Yasuo Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch |
title | Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch |
title_full | Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch |
title_fullStr | Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch |
title_full_unstemmed | Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch |
title_short | Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch |
title_sort | novel “red‐bull sign” during cavotricuspid isthmus ablation: indication of an ablation catheter stuck in the subeustachian pouch |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745479/ https://www.ncbi.nlm.nih.gov/pubmed/36524041 http://dx.doi.org/10.1002/joa3.12793 |
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