Index
Ep Defined | Getting Started | Working in the EP Lab
Right Atrium | Right Ventricle | Left Atrium | Left Ventricule | Cardiac Conduction | Cardiac Cell Properties | Action Potential | Sympathetic or Not | Med Page
Electrograms Defined | Recording Modes | Electrode Spacing | Filters | EGM Interpretation | Arrhythmia Analysis
The Physical Lab | Tools of the Trade
Setting Up | Catheter Placement | Baseline Measurement | SNRT | Conduction Study | Arrhythmia Induction | Pacing Protocols | Ablation | Tilt Table | Secrets to Success
Bradycardia | Atrial Tach | Atrial Flutter | Atrial Fibrillation | AVNRT | AVRT | Ventricular Tachycardia
Surface ECG's | Intracardiac Questions | Med Challenge | Advanced

Tools of the Trade - Ablation Generators

Ablation Systems

I mentioned earlier that the ablation catheter delivers radio frequency (RF) energy to the heart to destroy cells that may be causing the patient's arrhythmia. This is achieved using an RF generator. Energy from the generator is sent through a connecting cable to the ablation catheter where it is focused on a specific site within the patient's heart. The goal is to form a small, discreet scar at the selected site. Once formed, the scar prevents the transmission of electrical signals through that region and hopefully, the culprit arrhythmia will be terminated.

Most of the RF generators available today are very similar. With the exception of some minor differences, they all perform the same functions. Each unit generates radio frequency energy that is sent on to the catheter. They also the temperature at the tip of the catheter, the power required to achieve that temperature, the impedance measured by the system and the time the ablator has been delivering energy. These functions are very important and will help you to minimize potential complications during ablation.

When the ablator is set up, either temperature or power control must be selected. There is little operational difference in which one is chosen, though temperature control appears to be used most of the time. A desired temperature is selected and entered in the generator. The maximum power and duration of individual ablation runs, also called "burns", is chosen. When these parameters are all entered, you are ready to begin ablating. At this point, it is good to remember two things, never turn on the ablator unless you are absolutely certain the physician wants you to, and always be ready to turn the generator off.

Once you get the go ahead and the ablator is on, you will get continuous readings on your power, temperature, impedance and time. As the run progresses, you will need to read this information out to the physician at least every 15 seconds. If there is a significant change, you must let him know immediately to avoid any serious complications during the ablation. A sudden increase in temperature may indicate the catheter is not in good contact with the cardiac tissue and the blood in the immediate region could boil. A similar increase in impedance may indicate the catheter has advanced and may perforate the myocardium. If the impedance increases too quickly, most units have an automatic cutoff that will disengage the ablator. Always record the time and duration of each ablation run, along with the average power, temperature and impedance. Many systems have a computer interface that records this information automatically.

CRYO - Under development

 

 

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