Heart rhythm · 2026
Principles guiding PFA cardiac catheter and sheath management from preclinical assessment of microbubble formation and air intrusion models.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhang Xiao-Dong, Zou Fengwei, Gomez Tara, Byun Eric, Chen Qi, Marazzato Jacopo, Schiavone Marco, Mohanty Sanghamitra, La Fazia Vincenzo Mirco, Motta Jishu, Rosales Cristian Zamora, Pandey Shubhi, Safren Lowell, Shafir Yuval, Grupposo Vito, Ynoa Domingo, Lin Aung, Lakkireddy Dhanunjaya, Natale Andrea, Guttenplan Nils, Di Biase Luigi
Аннотация
BACKGROUND: Pulsed field ablation (PFA) may create gaseous microemboli, with large-tip catheters being a potential risk factor for further air intrusion. However, scant characterization exists for how optimization of catheter and sheath handling affects the microembolic load when handling large-tip devices. Given that most PFA catheters for treatment of atrial fibrillation have large tips, strategies to reduce gaseous emboli are critical.
OBJECTIVE: This study aimed to quantify microbubble formation and air intrusion of a PFA variable-loop circular catheter with a compatible guiding sheath during electrophysiology procedural steps under varying parametric conditions.
METHODS: 3 preclinical models were used. In an in vivo porcine model, blood was redirected from the carotid artery into an extracorporeal loop connected to an ultrasonic microbubble detector. Similarly, a benchtop in vitro circulating model was used with a microbubble detector. Finally, negative pressures were simulated on the benchtop to evaluate sheath-handling steps and the potential for air intrusion as measured by a syringe.
RESULTS: Catheter insertion through a sheath has a 7-fold higher proportion of bubbles >7 nL than ablation with the variable-loop circular catheter. Microbubble volume during insertion was reduced by 22%, 67%, and 78% with sheath submersion, irrigation, and aspiration, respectively. Air intrusion decreased by 55%, 56%, 65%, and 57% with sheath stopcock management, aspiration, irrigation, and slower sheath advancement, respectively.
CONCLUSION: Among the steps evaluated, catheter advancement through the sheath constitutes the most substantial procedural factor that may contribute to gaseous embolization. Careful management of these devices may mitigate embolic risk.
OBJECTIVE: This study aimed to quantify microbubble formation and air intrusion of a PFA variable-loop circular catheter with a compatible guiding sheath during electrophysiology procedural steps under varying parametric conditions.
METHODS: 3 preclinical models were used. In an in vivo porcine model, blood was redirected from the carotid artery into an extracorporeal loop connected to an ultrasonic microbubble detector. Similarly, a benchtop in vitro circulating model was used with a microbubble detector. Finally, negative pressures were simulated on the benchtop to evaluate sheath-handling steps and the potential for air intrusion as measured by a syringe.
RESULTS: Catheter insertion through a sheath has a 7-fold higher proportion of bubbles >7 nL than ablation with the variable-loop circular catheter. Microbubble volume during insertion was reduced by 22%, 67%, and 78% with sheath submersion, irrigation, and aspiration, respectively. Air intrusion decreased by 55%, 56%, 65%, and 57% with sheath stopcock management, aspiration, irrigation, and slower sheath advancement, respectively.
CONCLUSION: Among the steps evaluated, catheter advancement through the sheath constitutes the most substantial procedural factor that may contribute to gaseous embolization. Careful management of these devices may mitigate embolic risk.