Comparison of Monopolar and Bipolar Cox-Maze Ablation Based on Clinical Data and Mathematical Modeling
Keywords:heart, arrhythmia, radiofrequency ablation, monopolar electrode, bipolar electrode, mathematical modeling
Purpose: Today radiofrequency heart ablation is gold standard for the radical surgical treatment of different types of heart rhythm disturbances.The purpose of the research is a comparative analysis of monopolar and bipolar electrodes for ablation during open heart surgery (Cox-Maze ablation).
Methods: The analysis is made based on clinical data and mathematical modeling. By the use of system of electro-anatomical mapping of radiofrequency ablation zones a three-dimensional model of left atrium is created. Then a potential map, which represents the amplitude of myocardium activity, is imposed on this model. The amplitude of myocardium activity, the width and depth of the electro-thermal destruction zone and the ablation line continuity are main parameters of clinical data analysis. For mathematical modeling the COMSOL Multiphysics 5.4 software is used. Two variation of mathematical model for monopolar and bipolar ablation are created. Main analysis parameters of mathematical modeling are: diagrams of thermal field distribution, size of myocardial tissue destruction, and duration of the ablation procedure.
Results: Both monopolar and bipolar ablation can be used for Cox-Maze procedure. But potential map and mathematical modeling show that with monopolar ablation the destruction zone has a hemispherical shape and scar line is not uniform along the depth of a heated myocardial tissue. It can lead to a recovery of pathological signals conduction from the pulmonary veins to the atrium. Uneven distribution of thermal fields with a clearly defined maximum increases the risk of evaporation and microexplosions. At the same time the duration of monopolar ablation is significantly longer.
Conclusion: It is shown that bipolar ablation has advantages in pulmonary veins isolation. This type of instruments allows creation of effective and safe uniform thermal transmural destruction with only one application of radiofrequency current energy.
Berjano E. J. (2006) Theoretical modeling for radiofrequency ablation: state-of-the-art and challenges for the future. Biomedical engineering online, Vol. 5. DOI:10.1186/1475-925X-5-24.
Cox J. L., Schuessler R. B., D'Agostino H. J. Jr, Stone C. M., Chang B. C., Cain M. E., Corr P. B., Boineau J. P. (1991) The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. The Journal of Thoracic and Cardiovascular Surgery, Vol. 101, Iss. 4, pp. 569-583. DOI:10.1016/S0022-5223(19)36684-X.
Doss J. (1982) Calculation of electric fields in conductive media. Medical Physics, Vol. 9, Iss. 4, pp. 566–573. DOI:10.1118/1.595107.
Fedorova O. (2013) Vsemyrnaia orhanyzatsyia zdravookhranenyia podtverzhdaet hlobalnuiu эpydemyiu fybrylliatsyy predserdyi [World Health Organization confirms global epidemic of atrial fibrillation]. Ukrainskyi medychnyi zhurnal [Ukrainian medical journal]. [In Russian].
Labonte S. (1994) Numerical model for radio-frequency ablation of the endocardium and its experimental validation. IEEE Transactions on Biomedical Engineering, Vol. 41, Iss. 2, pp. 108–115. DOI:10.1109/10.284921.
Lawrance C., Henn M., Damiano Jr R. (2015) Surgical ablation for atrial fibrillation: techniques, indications, and results. Curr Opin Cardiol, Vol. 30, Iss. 1, pp. 58-64. DOI:10.1097/HCO.0000000000000125.
Pérez J., González-Suárez A., D’avila A., Berjano E. (2018) RF-energised intracoronary guidewire to enhance bipolar ablation of the interventricular septum: in-silico feasibility study. International Journal of Hyperthermia, Vol. 34, Iss. 8, pp. 1202-1212. DOI:10.1080/02656736.2018.1425487.
Saint L., Lawrance C., Okada Sh., Kazui T., Robertson J., et al. (2013) Performance of a Novel Bipolar/Monopolar Radiofrequency Ablation Device on the Beating Heart in an Acute Porcine Model. Innovations (Phila), Vol. 8, Iss. 4, pp. 276-283. DOI:10.1097/IMI.0b013e3182a77f2b.
Schutt D., Berjano E., Haemmerich D. (2009) Effect of electrode thermal conductivity in cardiac radiofrequency catheter ablation: a computational modeling study. Int J Hyperther. International Journal of Hyperthermia, Vol. 25, Iss. 2, pp. 99-107. DOI:10.1080/02656730802563051.
Siebermair J., Neumann B., Risch F., Riesinger L., Vonderlin N., et al. (2019) High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation - Two-year clinical outcome of a single center experience. Scientific Reports, Vol. 9, Article number: 8830. DOI:10.1038/s41598-019-45115-0.
Sychуk M. (2017) Catheter radiofrequency ablation of cardiac arrhythmogenic zones of improved efficiency and safety. PhD Thesis. Faculty of Biomedical Engineering National Technical University of Ukraine «Igor Sikorsky Kyiv Polytechnic Institute», Kyiv, Ukraine.
Tungjitkusolmun S. (2000) Finite element modeling of radio-frequency cardiac and hepatic ablation. PhD Thesis, University of Wisconsin.
Voeller R., Zierer A., Lall Sh., Sakamoto Sh., Schuessler R., et al. (2010) Efficacy of a novel bipolar radiofrequency ablation device on the beating heart for atrial fibrillation ablation: A long-term porcine study. The Journal of Thoracic and Cardiovascular Surgery, Vol. 140, Iss. 1, pp. 203-208. DOI:10.1016/j.jtcvs.2009.06.034.
Wang X., Gao H., Wu S., Bai Y., Zhou Z. (2018) RF ablation thermal simulation model: Parameter sensitivity analysis. Technology and Health Care : Official Journal of the European Society for Engineering and Medicine, Vol. 26, Iss. 1, pp. 179-192. DOI:10.3233/thc-174542.
Wei W., Ge J., Zou Y., Lin L., Cai Y., et al. (2014) Anatomical Characteristics of Pulmonary Veins for the Prediction of Postoperative Recurrence after Radiofrequency Catheter Ablation of Atrial Fibrillation. PLoS One, Vol. 9, Iss. 4, e93817. DOI:10.1371/journal.pone.0093817.
Whitaker J., Rajani R., Chubb H., Gabrawi M., Varela M., et al. (2016) The role of myocardial wall thickness in atrial arrhythmogenesis. Europace, Vol. 18, Iss. 12, pp. 1758-1772. DOI:10.1093/europace/euw014.
Wood M., Shaffer K., Ellenbogen A., Ownby E. (2005) Microbubbles during radiofrequency catheter ablation: composition and formation. Heart Rhythm, Vol. 2, Iss. 4, pp. 397-403. DOI:10.1016/j.hrthm.2004.12.026.
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Copyright (c) 2020 Марина Сичик, Юрій Стасюк, Віталій Максименко, Борис Кравчук
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