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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...

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Autores principales: Hirata, Moyuru, Nagashima, Koichi, Watanabe, Ryuta, Wakamatsu, Yuji, Otsuka, Naoto, Hayashida, Satoshi, Hirata, Shu, Sawada, Masanaru, Kurokawa, Sayaka, Okumura, Yasuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
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.
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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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