This section of the Radcliffe Cardiology website is dedicated to developing a greater understanding of how to create better lesions when using radiofrequency (RF) ablation.
Despite the widespread use of RF ablation in daily practice, it is perhaps surprising how much is still not understood about the basics of the biophysics underpinning RF ablation. Contact is clearly fundamental to successful ablation, and while the association between lesion size and contact force was investigated by David Haines in the early 90s, it is only in the last few years that we have had the tools to measure contact while performing ablations. How we interpret this data among the myriad of factors that affect lesion formation, is complicated by the endpoints that we have in clinical medicine. Recurrence of AF is a blunt tool, and even acute recurrence of conduction is relatively poor when we are trying to achieve permanent contiguous transmural lesions. Animal models with acute and chronic histological correlations are relatively few and far between and as always, the choice of model is critical.
The adoption of contact force sensing catheters continues to grow across the world, and there is an ever-expanding publication catalogue. In this section of the website I shall try and curate interesting articles and video interviews with a wide variety of practitioners and key opinion leaders to highlight the opinions and real world experiences of the busy practising electrophysiologist. While the focus will be around contact force, creating a lesion and treating AF requires a number of variables to be understood, and we will also be looking at how irrigation rates and power delivery can be optimised.
This month features the work of Roger Winkle who has long advocated high-power short-duration lesions, as well as recent work looking at catheter design to try and safely deliver even higher power for shorter durations. We also highlight Tilman Maurer's work on the STSF catheter. Mattias Duytschaever and Sebastian Knecht have been producing a series of work on meticulous RF delivery using ablation index: a composite of power, time and force, and lesion contiguity. We have also featured the work of David Haines and myself on real-time visualisation of lesion visualisation using an experimental ultrasound catheter.
I hope you enjoy visiting this website and find it useful in your everyday practice.
Dr Matt Wright