Gaps in the ablation line as a potential cause of recovery from electrical isolation and their visualization using mri

Ravi Ranjan, Ritsushi Kato, Menekhem M. Zviman, Timm M. Dickfeld, Ariel Roguin, Ronald D Berger, Gordon F. Tomaselli, Henry R Halperin

Research output: Contribution to journalArticle

Abstract

Background-Ablation has become an important tool in treating atrial fibrillation and ventricular tachycardia, yet the recurrence rates remain high. It is well established that ablation lines can be discontinuous and that conduction through the gaps in ablation lines can be affected by tissue heating. In this study, we looked at the effect of tissue conductivity and propagation of electric wave fronts across ablation lines with gaps, using both simulations and an animal model. Methods and Results-For the simulations, we implemented a 2-dimensional bidomain model of the cardiac syncytium, simulating ablation lines with gaps of varying lengths, conductivity, and orientation. For the animal model, transmural ablation lines with a gap were created in 7 mongrel dogs. The gap length was progressively decreased until there was conduction block. The ablation line with a gap was then imaged using MRI and was correlated with histology. With normal conductivity in the gap and the ablation line oriented parallel to the fiber direction, the simulation predicted that the maximum gap length that exhibited conduction block was 1.4 mm. As the conductivity was decreased, the maximum gap length with conduction block increased substantially, that is, with a conductivity of 67% of normal, the maximum gap length with conduction block increased to 4 mm. In the canine studies, the maximum gap length that displayed conduction block acutely as measured by gross pathology correlated well (R2 of 0.81) with that measured by MRI. Conclusions-Conduction block can occur across discontinuous ablation lines. Moreover, with recovery of conductivity over time, ablation lines with large gaps exhibiting acute conduction block may recover propagation in the gap over time, allowing recurrences of arrhythmias. The ability to see gaps acutely using MRI will allow for targeting these sites for ablation.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number3
DOIs
StatePublished - Jun 2011

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Animal Models
Recurrence
Electric Conductivity
Giant Cells
Ventricular Tachycardia
Heating
Atrial Fibrillation
Canidae
Cardiac Arrhythmias
Histology
Dogs
Pathology
Direction compound

Keywords

  • Ablation
  • Atrial Fibrillation
  • Gaps
  • MRI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Gaps in the ablation line as a potential cause of recovery from electrical isolation and their visualization using mri. / Ranjan, Ravi; Kato, Ritsushi; Zviman, Menekhem M.; Dickfeld, Timm M.; Roguin, Ariel; Berger, Ronald D; Tomaselli, Gordon F.; Halperin, Henry R.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 4, No. 3, 06.2011, p. 279-286.

Research output: Contribution to journalArticle

Ranjan, Ravi ; Kato, Ritsushi ; Zviman, Menekhem M. ; Dickfeld, Timm M. ; Roguin, Ariel ; Berger, Ronald D ; Tomaselli, Gordon F. ; Halperin, Henry R. / Gaps in the ablation line as a potential cause of recovery from electrical isolation and their visualization using mri. In: Circulation: Arrhythmia and Electrophysiology. 2011 ; Vol. 4, No. 3. pp. 279-286.
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abstract = "Background-Ablation has become an important tool in treating atrial fibrillation and ventricular tachycardia, yet the recurrence rates remain high. It is well established that ablation lines can be discontinuous and that conduction through the gaps in ablation lines can be affected by tissue heating. In this study, we looked at the effect of tissue conductivity and propagation of electric wave fronts across ablation lines with gaps, using both simulations and an animal model. Methods and Results-For the simulations, we implemented a 2-dimensional bidomain model of the cardiac syncytium, simulating ablation lines with gaps of varying lengths, conductivity, and orientation. For the animal model, transmural ablation lines with a gap were created in 7 mongrel dogs. The gap length was progressively decreased until there was conduction block. The ablation line with a gap was then imaged using MRI and was correlated with histology. With normal conductivity in the gap and the ablation line oriented parallel to the fiber direction, the simulation predicted that the maximum gap length that exhibited conduction block was 1.4 mm. As the conductivity was decreased, the maximum gap length with conduction block increased substantially, that is, with a conductivity of 67{\%} of normal, the maximum gap length with conduction block increased to 4 mm. In the canine studies, the maximum gap length that displayed conduction block acutely as measured by gross pathology correlated well (R2 of 0.81) with that measured by MRI. Conclusions-Conduction block can occur across discontinuous ablation lines. Moreover, with recovery of conductivity over time, ablation lines with large gaps exhibiting acute conduction block may recover propagation in the gap over time, allowing recurrences of arrhythmias. The ability to see gaps acutely using MRI will allow for targeting these sites for ablation.",
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AU - Kato, Ritsushi

AU - Zviman, Menekhem M.

AU - Dickfeld, Timm M.

AU - Roguin, Ariel

AU - Berger, Ronald D

AU - Tomaselli, Gordon F.

AU - Halperin, Henry R

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N2 - Background-Ablation has become an important tool in treating atrial fibrillation and ventricular tachycardia, yet the recurrence rates remain high. It is well established that ablation lines can be discontinuous and that conduction through the gaps in ablation lines can be affected by tissue heating. In this study, we looked at the effect of tissue conductivity and propagation of electric wave fronts across ablation lines with gaps, using both simulations and an animal model. Methods and Results-For the simulations, we implemented a 2-dimensional bidomain model of the cardiac syncytium, simulating ablation lines with gaps of varying lengths, conductivity, and orientation. For the animal model, transmural ablation lines with a gap were created in 7 mongrel dogs. The gap length was progressively decreased until there was conduction block. The ablation line with a gap was then imaged using MRI and was correlated with histology. With normal conductivity in the gap and the ablation line oriented parallel to the fiber direction, the simulation predicted that the maximum gap length that exhibited conduction block was 1.4 mm. As the conductivity was decreased, the maximum gap length with conduction block increased substantially, that is, with a conductivity of 67% of normal, the maximum gap length with conduction block increased to 4 mm. In the canine studies, the maximum gap length that displayed conduction block acutely as measured by gross pathology correlated well (R2 of 0.81) with that measured by MRI. Conclusions-Conduction block can occur across discontinuous ablation lines. Moreover, with recovery of conductivity over time, ablation lines with large gaps exhibiting acute conduction block may recover propagation in the gap over time, allowing recurrences of arrhythmias. The ability to see gaps acutely using MRI will allow for targeting these sites for ablation.

AB - Background-Ablation has become an important tool in treating atrial fibrillation and ventricular tachycardia, yet the recurrence rates remain high. It is well established that ablation lines can be discontinuous and that conduction through the gaps in ablation lines can be affected by tissue heating. In this study, we looked at the effect of tissue conductivity and propagation of electric wave fronts across ablation lines with gaps, using both simulations and an animal model. Methods and Results-For the simulations, we implemented a 2-dimensional bidomain model of the cardiac syncytium, simulating ablation lines with gaps of varying lengths, conductivity, and orientation. For the animal model, transmural ablation lines with a gap were created in 7 mongrel dogs. The gap length was progressively decreased until there was conduction block. The ablation line with a gap was then imaged using MRI and was correlated with histology. With normal conductivity in the gap and the ablation line oriented parallel to the fiber direction, the simulation predicted that the maximum gap length that exhibited conduction block was 1.4 mm. As the conductivity was decreased, the maximum gap length with conduction block increased substantially, that is, with a conductivity of 67% of normal, the maximum gap length with conduction block increased to 4 mm. In the canine studies, the maximum gap length that displayed conduction block acutely as measured by gross pathology correlated well (R2 of 0.81) with that measured by MRI. Conclusions-Conduction block can occur across discontinuous ablation lines. Moreover, with recovery of conductivity over time, ablation lines with large gaps exhibiting acute conduction block may recover propagation in the gap over time, allowing recurrences of arrhythmias. The ability to see gaps acutely using MRI will allow for targeting these sites for ablation.

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