Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Sep 14;23(1):13-15.
doi: 10.1016/j.jccase.2020.08.002. eCollection 2021 Jan.

Steam pop during cavo-tricuspid isthmus ablation shown by intracardiac echocardiography

Amato Santoro  1 , Andrea Romano  1 , Filippo Lamberti  2
Affiliations
Case Reports

Steam pop during cavo-tricuspid isthmus ablation shown by intracardiac echocardiography

Amato Santoro et al. J Cardiol Cases. .

Abstract

Steam pop (SP) refers to audible sound related to the intramyocardial explosion when tissue temperatures reach 100 °C. In this case the SP was recorded using intracardiac echocardiography (ICE), using Sound-star probe and Smart-touch catheter with ablation index (AI) module (Biosense-Webster Inc., Diamond-Bar, CA, USA). Guided by the anatomical reconstruction (EAM) and electrograms, we applied radiofrequencies (RF) in a "point-by-point" along the entire line on cavo-tricuspid-isthmus (CTI) using a target of an AI ≥500. The tip-tissue force recorded was 12-18 g and a power of 35 W. ICE imaging was important so that the anatomical position of the catheter tip can be precisely monitored. During RF, ICE showed a growing, hyperechogenic intramyocardial bubble at the catheter-tissue interface. ICE imaging showed a hyperechogenic intramyocardial formation at the moment of occurrence of the SP. ICE imaging showed that the formation suddenly expanded to a sphere over the course of several seconds. After SP we reduced the RF output energy from 35 W to 30 W. After RF line on CTI the patient had no complications and no recurrence of atrial flutter was recorded. <Learning objective: The use of intracardiac echocardiography during cavo-tricuspid-isthmus ablation permits the detection of the increase of microbubbles before steam pop formation.>.

Keywords: Atrial flutter catheter ablation; Intracardiac echocardiography; Steam pop; Transcatether ablation.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Steam-pop formation during RF (a–g). (a–d) The microbubbles were observed before steam pop; (e–g) ICE showed the growing, hyperechogenic intramyocardial bubbles and a tissue “explosion”. CTI: cavo-tricuspid-isthmus; ACT: ablation catheter; TV: tricuspid valve.
See this image and copyright information in PMC

References

    1. Viles-Gonzalez J.F., Berjano E., d’Avila A. Complications of radiofrequency catheter ablation: can we prevent steam pops? JACC Clin Electrophysiol. 2018;4:501–503. - PubMed
    1. Tokuda M., Tedrow U.B., Stevenson W.G. Silent steam pop detected by intracardiac echocardiography. Heart Rhythm. 2013;10:1558–1559. - PubMed
    1. Tokuda M., Kojodjojo P., Epstein L.M., Koplan B.A., Michaud G.F., Tedrow U.B. Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias. Circ Arrhythm Electrophysiol. 2011;4:660–666. - PubMed
    1. Seiler J., Roberts-Thomson K.C., Raymond J.M., Vest J., Delacretaz E., Stevenson W.G. Steam pops during irrigated radiofrequency ablation: feasibility of impedance monitoring for prevention. Heart Rhythm. 2008;5:1411–1416. - PubMed
    1. Cooper J.M., Sapp J.L., Tedrow U., Pellegrini C.P., Robinson D., Epstein L.M. Ablation with an internally irrigated radiofrequency catheter: learning how to avoid steam pops. Heart Rhythm. 2004;1:329–333. - PubMed

Publication types

LinkOut - more resources