BWI Foundations Week 2 - Catheters and Biophysics

What are the two classifications of catheters?

Therapeutic and diagnostic

What are therapeutic catheters?

Ablation catheters (deliver therapy)

What ablation catheters does Biosense have?

4mm, 8mm, Thermocool smart touch, Thermocool smart touch SF, Qdot

what does stsf stand for?

smart touch surround flow

What are the advanced diagnostic catheters?

Octaray, Optrell, Pentaray, Decanav, Lasso

Where do Octaray and Optrell plug into?

SPU

Where does the SPU Plug into?

20Pole A and 20pole B on PIU

What is the vizigo?

a bidirectional steerable sheath

What is the major advantage of Vizigo?

It has 4 electrodes that allow it to be visualized on the map. You can see sheath orientation without flouro

What size is vizigo?

8.5Fr inner diameter, 11.5Fr outer diameter

3 curve sizes

What are some advantages of vizigo?

understanding of sheath orientation w/o use of fluoro, stability, optimize tissue contact, may enhance efficiency during mapping and positioning, smooth tip-to-dialator transition

What can the vizigo pair with?

thermocool catheters

Where can you go to see if vizigo is paired?

cath tab, or right click on sheath itself on map. tip electrode will show solid for paired or X's for unpaired

What cables can be used with vizigo?

CB3412CT or CY1212CT (blue-blue or yellow-blue)

What is the connection order for catheters?

plug cable into catheter the cable into PIU

What catheters plug in SPU?

Octaray and Optrell

What is the SPU designed for?

bypass port limitations on PIU (needs to transmit more than 20 electrodes so it takes up both 20pole a and 20 pole b on PIU)

What is the Octaray catheter?

advanced diagnostic catheter with 8, 2Fr soft flexible splines, 48 staggered microelectrodes, and 3 shaft electrodes for visualization; approved for all 4 chambers

What is trueRef technology on Octaray?

mapping reference at base of splines that helps reduce noise and farfield signal

What are benefits of Octaray catheter?

-2x point density in 1/2 the time

-high electrode count increases acquisition speed and point density

-improved signal quality

-increased case efficiency

What are the 3 indicator colors on the SPU and what do they mean?

blue= powered on and initializing

green= ready for use

red= problem

where does the SPU get power from?

branched y power cable from power supply unit (other end goes to PIU)

What is the optrell catheter?

paddle shaped advanced diagnostic mapping catheter, with 6, 2 Fr splines, primarily used for ventricular mapping

What French size are the Octaray and Optrell?

8 Fr

What are auto Id catheters? What color is the catheter end of the cable?

auto-id catheters are automatically recognized by the PIU when plugged in, dark blue

What 2 cables are used for autoid catheters?

CB3412CT and CY1212CT

What 2 cables are used for non-auto ID catheters?

CB3410CT and CY1210CT

Where do you input non-auto ID catheters on the workstation?

Cath tab

Where do you change color of catheters, visualize electrodes, change signal colors for catheters?

cath tab

What are the distal electrodes?

electrodes at tip of catheter, farthest from cable connection (IE CS 1-2, Map 1-2)

What are the components of the RF circuit?

RF generator, catheter cable, catheter electrode, patient, grounding pad

What are the primary factors affection lesion formation?

power, contact force, time

What are the two types of heating in lesion formation?

conductive and resistive

What is resistive heating?

extends 3mm in, hottest portion, adjacent to cath tip

what is conductive heating?

can extend up to 7mm end, radiates from resistive heating zone

What are the two types of ablation catheters?

irrigated and solid tip

What are our solid tip ablation caths?

4mm, 8mm

what are our irrigated ablation caths?

thermocool sf, stsf, qdot

which type of ablation catheter creates a deeper lesion?

irrigated tip

What is the relationship between current density and catheter tip size?

inversely proportional, bigger tip=more dispersion of current=shallower lesion, smaller tip=more concentrated current= deeper lesion

What are the two modes ablation catheters can be put in?

temp control mode and power control mode

what happens in temperature control mode?

target temp set and power is titrated to achieve target temp

What catheters operated in temp control mode?

solid tip catheters and QDOT

What is power control mode?

target power is set and delivered regardless of temperature fluctuations

What ablation catheter operated in power control mode?

stsf

What is the boot up sequence of NGen?

NGen power supply, NGen system, primary monitor, secondary monitor, pump

What type of cable connect the NGen to the monitors?

ethernet

what type of cable connects NGen to workstation?

ethernet (must go in navigant Port in back of workstation)

what does the cable look like that connects the ngen to the pump?

grey cable with blue on both ends

What port on the back of a smartablate carries information from smartablate to workstation?

IOIO 2

What port on the back of the smartablate carries information to the recording system?

IOIOI 1

What cable connects the smartablate to the monitor?

grey cable with yellow on both ends

Verbalize the difference between therapeutic, advanced diagnostic and core diagnostic catheters

Therapeutic: ablation, stim, recording, EA mapping

Advance diagnostic: stim, recording, EA mapping, building matrix

Core diagnostic: stim recording only

What order doing you connect Vizigo and where does Vizigo plug into on PIU?

sheath to cable, cable to PIU. Plug into Quad B or DECA ports. NEVER Quad A.

What are the core diagnostic catheters?

Webster CS and Webster quadripolar

What are the sizes of Octaray?

8-2 French splines with 1. Standard (7.1cm2) 2-2-2, 1.5cm splines. 40 bipolar signals. 2. Long (12.6cm2) 2-5-2, 2.0cm splines. 24 bipolar signals. 3. 3-3-3, 2.0cm spines. 40 bipolar signals.

Connectology of Octaray

-2 fiberoptic cables (1 for PIU-workstation and 1 for PIU-SPU)

-Branched Y power cable for SPU and PIU from power source

-Octaray front interface cable

-2 20pole A/B interfance cables

Design of Optrell

-8 Fr

-6, 2-Fr splines

-8 electrodes per spline

-42 adjacent bipole pairs

-3 shaft electrodes for visualization

How are PFA lesions created?

electrical fields result in the formation of pores in the cell membrane. The creation of pores leads to an imbalance within the cell.

What is apoptosis?

programmed cell death due to imbalance inside the cell caused by pulsed field energy that cannot return to normal (IRREVERSIBLE ELECTROPORATION)

Benefits of PFA

-energy parameters are set in generator to causes apoptosis in the myocardium but not adjacent structures like the esophagus or phrenic nerve

Endpoint of PFA

PV electrogram reduction can occur with initial delivery but a subtherapeutic energy field can stun the tissue and cause electrograms to disappear. Applications beyond electrogram reduction are needed to ensure broad irreversible electroporation

What is the relationship with lesion size and contact force on PFA lesion?

increasing contact force increases lesion depth and width. Reduced or difficult catheter contact may lead to reconnects.

Verbalize connection QDOT Micro catheter and cable

-Ensure PIU is connected the RF generator prior to QDOT micro catheter use

-Cable must be kept at least 1 meter away from location pad

-Connect TX eco cable to PIU (first red cable into MAP port and wait for green LED on cable to stop blinking then yellow cable into QUAD B and waiting 10s for initialization)

-Connect QDOT Micro catheter to TX eco extension cable

- Connect TX eco extension cable to TX eco cable (wait 5 min for warm up period)

Verbalize disconnection of QDOT Micro catheter and cable

-Disconnect red cable, then yellow (do not leave one connected while other is disconnected)

-Once TX eco cable is disconnected, wait at least 10s before reconnecting

What is the additional round port on TX eco cable for?

to connect catheters which connect to the PIU MAP port when QDOT Micro catheter is not in use

What are the 3 indication colors on TX eco cable and what do they mean?

Blinking green = functionality testing is in progress

Steady green = cable is connected and functioning properly

Blinking red = cable malfunction

What information does the TX eco cable send?

transmission of force readings, location, intracardiac signals and temperature

Verbalize key features of QDOT Micro catheter

-3.5mm porous tip

-unidirectional or bidirectional

-contact force enabled

-3 microelectrodes

-6 thermocouples around tip

-angled irrigation holes

What is the benefit of microelectrodes?

Allows for discreet high resolution signals; less far field

Explain the 6 thermocouples on QDOT Micro.

-3 distal and 3 proximally placed close to tip tissue interface

-Allows for more reliable temperature feedback on an irrigated catheter

What is the benefit of having angled irrigation holes?

Allows for global cooling around ablation tip

Explain QMODE when using

Irrigation increases to 4mL per minute. Steep temperature rise causes burst of higher flow rate of 15mL/min. When temp drops, irrigation returns to lower flow rate. As irrigation reaches target temp, burst of high flow rate is delivered until temp drops below target temp. If temp exceeds target, another burst of high flow rate and a decrease in power delivered. When temp drops again, power increases, flow rate decreases.

Explain QMODE when using >35 watts

Irrigation flow rate starts at 15mL/min. If temp does not rise, irrigation rate drops to 4mL/min until temp exceeds preset max low flow temp value. Once temp exceeds low flow temp value, irrigation increases to 15mL/min. Irrigation and power are auto adjusted to maintain temp between max low flow temp and target temp.

What is target power?

The value of power you want to reach

What is RF duration?

The time energy is delivered per lesion

What is target temperature?

The temperature value you do not want to exceed per lesion (5 degrees C less than the cuttoff)

What is cutoff temperature?

The temperature value which will auto shut off energy delivery to not exceed this value

What is max low flow temperature?

Max temp value that the low irrigation rate will be active before changing to higher flow rate

QMODE+

high power, short duration. 90W at 4s

What happens when QMODE+ target temperature not reached?

Ablation application is activated, 2s pre-RF delay begins for high flow rate to cool surface tissue then 90W for at least 4s will be delivered

What happens when QMODE+ target temperature is reached?

Power is modulated down to prevent overheating. Power continues to modulate in response to temp for duration of application.

What are the results of lesion comparison between QMODE+ and standard power control?

QMODE+ lesion is significantly shallower, smaller diameter than standard power-controlled ablation. Good for areas of thinner tissue such as posterior wall.

How do the spring and sensors relate to the grams of force on screen and vector deflection on thermocool ST catheter?

The sensors monitor the transmitter coils location and records micro-movements of the spring. The Spring allows small amount of electrode deflection. and the Transmitter coil in the tip sends location reference signal about the spring.