Gastric slow‐wave modulation via power‐controlled, irrigated radio‐frequency ablation

Background Recently, radio‐frequency ablation has been used to modulate slow‐wave activity in the porcine stomach. Gastric ablation is, however, still in its infancy compared to its history in the cardiac field, and electrophysiological studies have been restricted to temperature‐controlled, non‐irr...

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Published in:Neurogastroenterology and motility 2024-09, Vol.36 (9), p.e14873-n/a
Main Authors: Matthee, Ashton, Aghababaie, Zahra, Nisbet, Linley A., Simmonds, Sam, Dowrick, Jarrah M., Sands, Gregory B., Angeli‐Gordon, Timothy R.
Format: Article
Language:English
Subjects:
Ablation
catheter ablation
Catheters
Electrophysiology
gastrointestinal
Irrigation
Lesions
radio‐frequency ablation
stomach
Temperature
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Summary:Background Recently, radio‐frequency ablation has been used to modulate slow‐wave activity in the porcine stomach. Gastric ablation is, however, still in its infancy compared to its history in the cardiac field, and electrophysiological studies have been restricted to temperature‐controlled, non‐irrigated ablation. Power‐controlled, irrigated ablation may improve lesion formation at lower catheter‐tip temperatures that produce the desired localized conduction block. Methods and Results Power‐controlled, irrigated radio‐frequency ablation was performed on the gastric serosal surface of female weaner pigs (n = 5) in vivo. Three combinations of power (10–15 W) and irrigation settings (2–5 mL min−1) were investigated. A total of 12 linear lesions were created (n = 4 for each combination). Slow waves were recorded before and after ablation using high‐resolution electrical mapping. Key Results Irrigation maintained catheter‐tip temperature below 50°C. Ablation induced a complete conduction block in 8/12 cases (4/4 for 10 W at 2 mL min−1, 1/4 for 10 W at 5 mL min−1, 3/4 for 15 W at 5 mL min−1). Blocks were characterized by a decrease in signal amplitude at the lesion site, along with changes in slow‐wave propagation patterns, where slow waves terminated at and/or rotated around the edge of the lesion. Conclusions and Inferences Power‐controlled, irrigated ablation can successfully modulate gastric slow‐wave activity at a reduced catheter‐tip temperature compared to temperature‐controlled, non‐irrigated ablation. Reducing the irrigation rate is more effective than increasing power for blocking slow‐wave activity. These benefits suggest that irrigated ablation is a suitable option for further translation into a clinical intervention for gastric electrophysiology disorders. Power‐controlled, irrigated radio‐frequency ablation creates lesions which effectively modulates gastric slow‐wave activity by preventing slow‐wave conduction across the lesion. High‐resolution electrical mapping shows rotation of waves around the lesion from early (red) to late (blue) activation times.
ISSN:1350-1925
1365-2982
1365-2982
DOI:10.1111/nmo.14873