Transmural Temperature Monitoring to Quantify Thermal Conduction And Lesion Formation During Gastric Ablation, an Emerging Therapy for Gastric Dysrhythmias

Gastric ablation is emerging as a potential therapy for electrical dysrhythmias associated with gastric disorders. Thermal conduction properties of gastric tissue during ablation have not yet been defined, but are necessary for optimizing the technique and translating ablation to clinical therapy. We developed custom needle-based transmural temperature probes to quantify the temperature of gastric tissue during ablation. These probes were applied in vivo in pigs (n=5), during gastric ablation (70 °C, 10 s duration), at distances of 2.5 – 20 mm from the ablation catheter tip. Thermal response of the tissue was non-linear; the maximum temperature increase from baseline (33.3 ± 1.0 °C) was observed at the closest temperature probe to the catheter tip (2.5 mm, 14.9 °C), and temperature change decreased with distance from the catheter tip. Probes positioned between 5 -20 mm from the catheter tip recorded temperature increases of less than 5.6 °C. This study provides methods for monitoring temperature during in vivo ablation, and demonstrates that functional temperature increases from ablation were restricted to within approximately 5 mm of the catheter. These methods can now be applied to optimize effective ablation parameters, and to inform models of gastric ablation.

[1]  Leo K. Cheng,et al.  Progress in Mathematical Modeling of Gastrointestinal Slow Wave Abnormalities , 2018, Front. Physiol..

[2]  Leo K. Cheng,et al.  Methods for High-Resolution Electrical Mapping in the Gastrointestinal Tract , 2019, IEEE Reviews in Biomedical Engineering.

[3]  Leo K. Cheng,et al.  The virtual intestine: in silico modeling of small intestinal electrophysiology and motility and the applications , 2016, Wiley interdisciplinary reviews. Systems biology and medicine.

[4]  S L Dawson,et al.  Tissue ablation with radiofrequency: effect of probe size, gauge, duration, and temperature on lesion volume. , 1995, Academic radiology.

[5]  Andrew J. Pullan,et al.  Abnormal initiation and conduction of slow-wave activity in gastroparesis, defined by high-resolution electrical mapping. , 2012, Gastroenterology.

[6]  P. Wolf,et al.  Temperature-controlled and constant-power radio-frequency ablation: what affects lesion growth? , 1999, IEEE Transactions on Biomedical Engineering.

[7]  W E Bolch,et al.  Individual variations in mucosa and total wall thickness in the stomach and rectum assessed via endoscopic ultrasound. , 2003, Physiological measurement.

[8]  G. O’Grady,et al.  Challenges in defining, diagnosing, and treating diabetic gastroparesis. , 2018, Journal of diabetes and its complications.

[9]  Leo K. Cheng,et al.  Feasibility of High-Resolution Electrical Mapping for Characterizing Conduction Blocks Created by Gastric Ablation , 2019, 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[10]  J. Svendsen,et al.  Tissue Temperatures and Lesion Size During Irrigated Tip Catheter Radiofrequency Ablation: An In Vitro Comparison of Temperature‐Controlled Irrigated Tip Ablation, Power‐Controlled Irrigated Tip Ablation, and Standard Temperature‐Controlled Ablation , 2000, Pacing and clinical electrophysiology : PACE.

[11]  Leo K. Cheng,et al.  Recent progress in gastric arrhythmia: Pathophysiology, clinical significance and future horizons , 2014, Clinical and experimental pharmacology & physiology.

[12]  Leo K. Cheng,et al.  Slow wave coupling across a gastroduodenal anastomosis as a mechanism for post-surgical gastric dysfunction: evidence for a 'Gastrointestinal Aberrant Pathway'. , 2019, American journal of physiology. Gastrointestinal and liver physiology.

[13]  S. Kapa,et al.  Electroporation: past and future of catheter ablation. , 2014, Circulation. Arrhythmia and electrophysiology.

[14]  G. Farrugia Interstitial cells of Cajal in health and disease , 2008, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[15]  J. Tack The difficult patient with gastroparesis. , 2007, Best practice & research. Clinical gastroenterology.

[16]  L. Comolli,et al.  Temperature distribution during RF ablation on ex vivo liver tissue: IR measurements and simulations , 2015 .

[17]  Leo K. Cheng,et al.  Loss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting. , 2015, Gastroenterology.

[18]  F. Morady Radio-frequency ablation as treatment for cardiac arrhythmias. , 1999, The New England journal of medicine.