Dataset Information

Evaluation of ablation catheter technology: Comparison between thigh preparation model and an in vivo beating heart.

ABSTRACT:

Background

An in vivo animal thigh model is the standard technique for evaluation of ablation catheter technologies, including efficacy and safety of ablation. However, the biophysics of ablation in a thigh model may not be similar to a beating heart.

Objective

The purpose of this study was to compare efficacy and safety of ablation between a thigh preparation model and a beating heart.

Methods

In 7 swine, radiofrequency ablation using a 3.5-mm open irrigated catheter (ThermoCool Smart Touch) was performed sequentially in a thigh muscle and in vivo beating ventricles. Ablation was performed at low (30 W for 40 s) and high (40 W for 60 s) energy settings and at similar contact force. Ablation lesions were scanned in high resolution and measured using electronic calipers.

Results

A total of 152 radiofrequency ablation lesions were measured (86 thigh and 66 heart). At low energy, lesion width was greater in the thigh model (12.19 ± 1.8 mm vs 8.99 ± 2.1 mm; P <.001), whereas lesion depth was similar between the thigh and heart (5.71 ± 0.8 mm vs 5.95 ± 1.3 mm, respectively; P = .18). The planar cross-sectional lesion area was greater in the thigh model (thigh 54.8 ± 10.8 mm² vs heart 43.1 ± 16.1 mm²; P <.001). At the high-energy setting, lesion depth, width, and area were all greater in the thigh model (thigh 91.5 ± 16.8 mm² vs heart 56.0 ± 15.5 mm²; P <.001). The incidence of steam pop and char formation was similar between the models.

Conclusion

The thigh preparation model is a reasonable technique for evaluation of ablation catheter technology; however it often results in overestimation of lesion size, especially at higher energy settings.

SUBMITTER: Leshem E

PROVIDER: S-EPMC5669034 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Publications

Evaluation of ablation catheter technology: Comparison between thigh preparation model and an in vivo beating heart.

Leshem Eran E Tschabrunn Cory M CM Contreras-Valdes Fernando M FM Zilberman Israel I Anter Elad E

Heart rhythm 20170426 8

<h4>Background</h4>An in vivo animal thigh model is the standard technique for evaluation of ablation catheter technologies, including efficacy and safety of ablation. However, the biophysics of ablation in a thigh model may not be similar to a beating heart.<h4>Objective</h4>The purpose of this study was to compare efficacy and safety of ablation between a thigh preparation model and a beating heart.<h4>Methods</h4>In 7 swine, radiofrequency ablation using a 3.5-mm open irrigated catheter (Ther ...[more]

PMID: 28455271

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Project description:BackgroundRandomized clinical trials have demonstrated that catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction may improve survival and other cardiovascular outcomes.MethodsWe constructed a decision-analytic Markov model to estimate the costs and benefits of catheter ablation and medical management in patients with symptomatic heart failure with reduced ejection fraction (left ventricular ejection fraction ≤35%) and atrial fibrillation over a lifetime horizon. Evidence from the published literature informed the model inputs, including clinical effectiveness data from meta-analyses. Probabilistic and deterministic sensitivity analyses were performed. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective.ResultsCatheter ablation was associated with 6.47 (95% CI, 5.89-6.93) quality-adjusted life years (QALYs) and a total cost of $105 657 (95% CI, $55 311-$191 934; 2018 US dollars), compared with 5.30 (95% CI, 5.20-5.39) QALYs and $63 040 (95% CI, $37 624-$102 260) for medical management. The incremental cost-effectiveness ratio for catheter ablation compared with medical management was $38 496 (95% CI, $5583-$117 510) per QALY gained. Model inputs with the greatest variation on incremental cost-effectiveness ratio estimates were the cost of ablation and the effect of catheter ablation on mortality reduction. When assuming a more conservative estimate of the treatment effect of catheter ablation on mortality (hazard ratio of 0.86), the estimated incremental cost-effectiveness ratio was $74 403 per QALY gained. At a willingness-to-pay threshold of $100 000 per QALY gained, atrial fibrillation ablation was found to be economically favorable compared with medical management in 95% of simulations.ConclusionsCatheter ablation in patients with heart failure with reduced ejection fraction patients and atrial fibrillation may be considered economically attractive at current benchmarks for societal willingness-to-pay in the United States.

Dataset Information

Evaluation of ablation catheter technology: Comparison between thigh preparation model and an in vivo beating heart.

Background

Objective

Methods

Results

Conclusion

Publications

Evaluation of ablation catheter technology: Comparison between thigh preparation model and an in vivo beating heart.

Similar Datasets

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