Ana González-Suárez

Comparative Analysis of Different Methods of Modeling the Thermal Effect of Circulating Blood Flow During RF Cardiac Ablation

Our aim was to compare the different methods of modeling the effect of circulating blood flow on the thermal lesion dimensions created by radio frequency (RF) cardiac ablation and on the maximum blood temperature. Computational models were built to study the temperature distributions and lesion dimensions created by a nonirrigated electrode by two RF energy delivery protocols (constant voltage and constant temperature) under high and low blood flow conditions. Four methods of modeling the effect of circulating blood flow on lesion dimensions and temperature distribution were compared. Three of them considered convective coefficients at the electrode-blood and tissue-blood interfaces to model blood flow: 1) without including blood as a part of the domain; 2) constant electrical conductivity of blood; and 3) temperature-dependent electrical conductivity of blood (+2%/°C). Method 4) included blood motion and was considered to be a reference method for comparison purposes. Only Method 4 provided a realistic blood temperature distribution. The other three methods predicted lesion depth values similar to those of the reference method (differences smaller than 1 mm), regardless of ablation mode and blood flow conditions. Considering the aspects of lesion size and maximum temperature reached in blood and tissue, Method 2 seems to be the most suitable alternative to Method 4 in order to reduce the computational complexity. Our findings could have an important implication in future studies of RF cardiac ablation, in particular, in choosing the most suitable method to model the thermal effect of circulating blood.

Radiofrequency cardiac ablation with catheters placed on opposing sides of the ventricular wall: computer modelling comparing bipolar and unipolar modes.

Abstract Purpose: The aim of this study was to compare the efficacy of bipolar (BM) vs. unipolar (UM) mode of radiofrequency ablation (RFA) in terms of creating transmural lesions across the interventricular septum (IVS) and ventricular free wall (VFW). Materials and methods: We built computational models to study the temperature distributions and lesion dimensions created by BM and UM on IVS and VFW during RFA. Two different UM types were considered: sequential (SeUM) and simultaneous (SiUM). The effect of ventricular wall thickness, catheter misalignment, epicardial fat, and presence of air in the epicardial space were also studied. Results: Regarding IVS ablation, BM created transmural and symmetrical lesions for wall thicknesses up to 15 mm. SeUM and SiUM were not able to create transmural lesions with IVS thicknesses ≥12.5 and 15 mm, respectively. Lesions were asymmetrical only with SeUM. For VFW ablation, BM also created transmural lesions for wall thicknesses up to 15 mm. However, with SeUM and SiUM transmurality was obtained for VFW thicknesses ≤7.5 and 12.5 mm, respectively. With the three modes, VFW lesions were always asymmetrical. In the scenario with air or a fat tissue layer on the epicardial side, only SiUM was capable of creating transmural lesions. Overall, BM was superior to UM in IVS and VFW ablation when the catheters were not aligned. Conclusions: Our findings suggest that BM is more effective than UM in achieving transmurality across both ventricular sites, except in the situation of the epicardial catheter tip surrounded by air or placed over a fat tissue layer.

Feasibility study of an internally cooled bipolar applicator for RF coagulation of hepatic tissue: Experimental and computational study

Purpose: To study the capacity of an internally cooled radiofrequency (RF) bipolar applicator to create sufficiently deep thermal lesions in hepatic tissue. Materials and methods: Three complementary methodologies were employed to check the electrical and thermal behaviour of the applicator under test. The experimental studies were based on excised bovine (ex vivo study) and porcine liver (in vivo study) and the theoretical models were solved by means of the finite element method (FEM). Results: Experimental and computational results showed good agreement in terms of impedance progress and lesion depth (4 and 4.5 mm respectively for ex vivo conditions, and ≈7 and 9 mm respectively for in vivo conditions), although the lesion widths were overestimated by the computer simulations. This could have been due to the method used to assess the thermal lesions; the experimental lesions were assessed by the white coagulation zone, whereas the tissue damage function was used to assess the computational lesions. Conclusions: The experimental results suggest that this applicator could create in vivo lesions to a depth of around 7 mm. It was also observed that the thermal lesion is mainly confined to the area between both electrodes, which would allow lesion width to be controlled by selecting a specific applicator design. The comparison between the experimental and computational results suggests that the theoretical model could be usefully applied in further studies of the performance of this device.

Thermal and elastic response of subcutaneous tissue with different fibrous septa architectures to RF heating: numerical study.

Radiofrequency currents are commonly used in dermatology to treat cutaneous and subcutaneous tissues by heating. The subcutaneous morphology of tissue consists of a fine, collagenous and fibrous septa network enveloping clusters of adipocyte cells. The architecture of this network, namely density and orientation of septa, varies among patients and, furthermore, it correlates with cellulite grading. In this work we study the effect of two clinically relevant fibrous septa architectures on the thermal and elastic response of subcutaneous tissue to the same RF treatment; in particular, we evaluate the thermal damage and thermal stress induced to an intermediate‐ and a high‐density fibrous septa network architecture that correspond to clinical morphologies of 2.5 and 0 cellulite grading, respectively.

Could the heat sink effect of blood flow inside large vessels protect the vessel wall from thermal damage during RF-assisted surgical resection?

PURPOSE To assess by means of computer simulations whether the heat sink effect inside a large vessel (portal vein) could protect the vessel wall from thermal damage close to an internally cooled electrode during radiofrequency (RF)-assisted resection. METHODS First,in vivo experiments were conducted to validate the computational model by comparing the experimental and computational thermal lesion shapes created around the vessels. Computer simulations were then carried out to study the effect of different factors such as device-tissue contact, vessel position, and vessel-device distance on temperature distributions and thermal lesion shapes near a large vessel, specifically the portal vein. RESULTS The geometries of thermal lesions around the vessels in the in vivo experiments were in agreement with the computer results. The thermal lesion shape created around the portal vein was significantly modified by the heat sink effect in all the cases considered. Thermal damage to the portal vein wall was inversely related to the vessel-device distance. It was also more pronounced when the device-tissue contact surface was reduced or when the vessel was parallel to the device or perpendicular to its distal end (blade zone), the vessel wall being damaged at distances less than 4.25 mm. CONCLUSIONS The computational findings suggest that the heat sink effect could protect the portal vein wall for distances equal to or greater than 5 mm, regardless of its position and distance with respect to the RF-based device.

Theoretical and experimental study on RF tumor ablation with internally cooled electrodes: When does the roll-off occur?

The Cool-tip is one of the most widely employed electrodes in radiofrequency (RF) ablation (RFA) of hepatic tumors. This electrode creates reliable geometry and coagulation zones. Despite the advantages of this electrode, during the ablation is produced a phenomenon called roll-off in which impedance increases, energy deposition completely stops and the lesion size cannot be increased. Consequently, the thermal lesion size is smaller and the tumors which can be ablated are smaller too. In this research we studied theoretical and experimentally the electrical-thermal performance of the Cool-tip electrode during RFA of hepatic tissue. Mainly, we were interested in the occurrence of the roll-off and its relationship with the tissue temperatures around the electrode. The theoretical model included the vaporization of the tissue and the variation of the thermal and electrical conductivities with temperature. The model was solved numerically using COMSOL Multiphysics software. For the experimental part we conducted a study in ex vivo liver tissue. The experimental and theoretical results showed that the roll-off is totally related when temperatures around 100°C surrounds the tissue close to the center of the Cool-tip. The knowledge of this fact brings a powerful tool to analyze alternative methods or techniques to avoid the roll-off.

Experimental and theoretical study of an internally cooled bipolar electrode for RF coagulation of biological tissues

Although some types of bipolar electrodes have been broadly employed in clinical practice to coagulate biological tissue by means of radiofrequency (RF) currents, there is still scanty available information about their electrical-thermal behaviour. We are focused on internally cooled bipolar electrodes. The goal of our study was to know more about the behavior of this kind of electrodes. For that, we planned an experimental and theoretical model. The experimental study was based on bovine hepatic ex vivo tissue and the theoretical model was based on the Finite Element Method (FEM). In order to check the feasibility of the theoretical model, we assessed both theoretically and experimentally the effect of the internal cooling characteristics of the bipolar electrode (flow rate and coolant temperature) on the impedance progress during RF heating and coagulation zone dimensions. The experimental and theoretical results were in good agreement, which suggests that the theoretical model could be useful to improve the design of cooled bipolar electrodes.

Numerical analysis of thermal impact of intramyocardial capillary blood flow during radiofrequency cardiac ablation

Abstract Purpose: The thermal effect of the intramyocardial blood perfusion on the size of lesions created by radiofrequency cardiac ablation (RFCA) has not been adequately studied to date. Our objective was to assess the impact of including this phenomenon in RFCA computer modelling in terms of the thermal lesion depth created. Methods: A computer model was built and computer simulations were conducted to assess the effect of including the blood perfusion term in the bioheat equation. This term mimics the intramyocardial blood flow (i.e., blood perfusion) in the cardiac wall at the site at which the RFCA is being conducted and hence represents a heat removing mechanism. When considered, blood perfusion rates ranged from 609 to 1719 ml/min/kg. Two electrode design and modes were considered: a non-irrigated electrode with constant temperature mode and an irrigated electrode with constant power mode. Results: All the depths computed without including the blood perfusion term were larger than those that did include it, regardless of perfusion rate. The differences in lesion depth between ignoring and including blood perfusion increased over time; for a 60 s RFCA they were 0.45 and 1 mm for minimum and maximum perfusion rate, respectively. The differences were more or less independent of blood flow in the cardiac chamber, electrode type and ablation mode. Conclusions: The findings suggest that the heat-sink effect of blood perfusion should be taken into account in the case of ablations (>1 minute) such as those conducted in RFCA of the ventricular wall.

Computational Study to Assess Whether the Heat Sink Effect of Blood Flow Inside the Portal Vein Could Thermally Protect Its Wall during RF-Assisted Resection

The aim of our study was to assess whether the heat sink effect inside the portal vein could protect its wall from thermal damage close to an internally cooled electrode during RF-assisted resection. Computer simulations were carried out to study the effect of different factors such as device-tissue contact, vessel position and vessel-device distance on temperature distributions and thermal lesion shapes near the portal vein. Our results suggest that the heat sink effect could protect the portal vein wall for distances equal to or greater than 5 mm, regardless of its position and distance with respect to the RF-based device.