This month, we welcome Matthew Dare, CEPS, as guest blogger on the TCAI blog. Matt is Research and Technology Coordinator at TCAI and is our go-to guy whenever we have questions or issues with the high-tech equipment used in the EP Lab here. Matt’s expertise is invaluable to the daily operation of the lab. If you have questions for Matt, please feel free to contact him at firstname.lastname@example.org.
One of the things I have always loved about EP is the myriad of cutting edge technologies we use on a daily basis. With technologies such as integrated control and video systems, 3D mapping, remote navigation, telepresence and a dizzying array of ablation technologies that include radiofrequency, cryo and lasers, a modern EP lab resembles something closer to a video game or mission control at NASA than an operating room. And as a member of a generation raised on video games, I feel right at home.
Now, we didn’t get to this point of high tech integration overnight. It has taken years and years of advances to get us to where we are now. With that thought in mind, I’d like to look back on the advances of this past year and some promising pieces of technology we might see in the coming year.
- New Irrigated Catheter Designs – Several companies are in the midst of studies new irrigated catheters that promise better lesion formation with more efficient cooling. These more efficient designs allow for lower saline flow rates than those currently on the market. This will help offset some the fluid overload issues we see with current catheters. One thing to watch with these new catheters will be how lab practices change due to the lack of temperature feedback from the catheter.
- Force Sensing Catheters – Contact force has always been a factor in creating good lesions, but up until now, physicians have not had a reliable way of determining how much force they are actually applying to the tissue. That will change with the catheters currently being studied as both competing technologies, magnetic sensor based and fiber optic sensor based, will allow physicians to determine contact pressure down to one gram. Ideally this should allow for better, more consistent lesion formation while also helping prevent complications from applying too much pressure.
- Multielectrode RF – While this technology has been studied for several years, the EP community was able to see more data this year along with broader investigational use. The idea of being able to create complex lesion sets with a single application is very intriguing. Unfortunately, the current non-irrigated implementation of this technology has had difficulty in creating deep lesions. In addition, several centers and studies have reported a significant rate of silent embolization in cases utilizing the current system. The addition of irrigation electrodes has the potential to solve both of these issues.
- Cryo Balloon – This year, the cryo balloon became just the second device to receive an indication for paroxysmal atrial fibrillation from the FDA. Since receiving that indication, the cryo balloon has enabled many centers that were not previously equipped for AF ablations to perform this complex procedure. As the device is limited to isolation of the pulmonary veins, it does have its limits, but it has the potential to be an important tool in the EP toolbox.
- Laser Balloon – The laser balloon is another device that has been in studies for several years, but has recently gone through a redesign of the laser console and of the balloon itself. These changes have made the system much more user friendly than previous iteration and even allow for one handed operation of the balloon by the physician. While the laser balloon is similar to the cryo balloon in the fact that it is basically limited to isolating the pulmonary veins, it provides the physician with the ability to target specific regions around the pulmonary veins. In addition to more localized ablation, the laser balloon also allows physicians to actually see where the lesions are being placed via an endoscope located within the balloon itself.
- Radiometric Temperature Sensing Catheter – The last technology I want to mention is a newer system that allows for the measurement of actual tissue temperature. This device integrates passive radiometric sensors into the tip of an irrigated ablation catheter rather than the traditional thermocouple or thermister found in most ablation catheters. The systems works by detecting microwaves emitted from heated tissue during radiofrequency ablation. This enables the physician to see the temperature of the tissue three millimeters from the tip of the catheter. As I mentioned earlier, one of the drawbacks of newer irrigated catheter designs is that they provide no real temperature feedback during ablation. This system has the potential to remedy that issue.
As you can see, this upcoming year promises to be another year filled with exciting advances in EP. Hopefully these new technologies will allow the EP community to provide broader access and improved outcomes for our patients. It will certainly be interesting to see what we think a year from now