AMEN and ALARA – Remembering the dangers of the (new) technology of
lesion formation
Abstract
Catheter ablation in children has evolved to become a highly effective
and safe therapy. Each iterative improvement in ablation technology
provides another opportunity to investigate how much incremental benefit
can be made without sacrificing safety. Contact force sensing catheters
represent an example of such technology that has become commonplace in
adult ablation. Its capability in predicting lesion size and collateral
damage to critical structures has not been meticulously explored.
Backhoff and colleagues describe an animal ablation model where they
quantitate lesion characteristics at the atrium, atrioventricular
groove, and ventricle using low and high contact force targets, with a
specific focus on assessing for coronary arterial injury. In this
controlled experiment, chronic lesion characteristics were widely
variable (~0-8 mm diameter) yet there was a
statistically significant (albeit small) increase in lesion diameter for
high (vs low) contact force lesions delivered to the atrioventricular
groove. The risk of chronic sub-clinical coronary artery injury was
1-2%.