Johnson & Johnson Biosense Webster THERMOCOOL SMARTTOUCH SF Mode D'emploi page 7

8. When applying high lateral force during mapping and RF application, the
user should monitor the contact force Dashboard and vector display on the
®
C 3 screen to ensure that contact force measurements remain within
ARTO
the accurate range. Refer to the Error Messages and Alerts section of the
®
C 3 System Instructions for Use for System-related alert messages
ARTO
and indications related to inaccurate force readings.
9. Do not use the temperature sensor to monitor tissue temperature. The
temperature sensor located within the tip section of the catheter does not
reflect either electrode-tissue interface or tissue temperature due to the
cooling effects of the saline irrigation of the electrode. The temperature
displayed on the RF generator is the temperature of the cooled electrode,
not tissue temperature. The temperature sensor is used to verify that the
irrigation flow rate is adequate. Before initiating the application of RF
current, a decrease in electrode temperature confirms the onset of saline
irrigation of the ablation electrode. Monitoring the temperature from the
electrode during the application of RF current ensures that the irrigation flow
rate is being maintained.
10. Do not rely on electrode temperature rise to determine if tissue heating is
occurring during RF energy delivery as bench and animal studies showed
no significant electrode temperature rise during RF ablation.
11. It is important to carefully follow the power titration procedure as specified in
the instructions for use. Too rapid an increase in power during ablation may
lead to perforation caused by steam pop.
12. This catheter may damage the prosthetic tricuspid valve of a patient if the
catheter is accidentally advanced through the valve.
13. The patient who has had a prior atrial flutter ablation procedure may be at
greater risk for perforation and/or pericardial effusion with the use of this
catheter system.
14. In accordance with your hospital's protocol, monitor the patient's fluid
balance throughout the procedure to avoid fluid volume overload. Some
patients may have factors that reduce their ability to handle the volume
overload, making them susceptible to developing pulmonary edema or heart
failure during or after the procedure. Patients with congestive heart failure or
renal insufficiency, and the elderly are particularly susceptible. Prior to the
procedure, always identify the patient's risk of volume overload.
15. The safety of discontinuing anticoagulation therapy following catheter
ablation of atrial fibrillation has not been established; anticoagulation
therapy in such patients should be administered in accordance with the
ACC/AHA/ESC Guidelines for the Management of Patients with Atrial
Fibrillation.
16. To avoid thromboemboli, intravenous heparin should be used when entering
the left heart during ablation. Follow the clinical guideline and common
practice for optimal post-procedural anticoagulation.
17. The safety and effectiveness of radiofrequency ablation for the treatment of
atrial fibrillation in patients with significant left ventricular dysfunction,
advanced heart failure, substantial left atrial enlargement, and structural
heart disease have not been established.
18. The catheter has not been shown to be safe at electrode temperatures
above 40°C. Verify the CATHETER SELECTION KNOB on the compatible
RF generator is on the "TCool SF" or Thermocool SF similar option and
ensure that the maximum temperature is set at 40°C.
19. Implantable pacemakers and implantable cardioverter/defibrillator (ICDs)
may be adversely affected by RF current. It is important to have temporary
external sources of pacing and defibrillation available during ablation and to
temporarily reprogram the pacing system to minimum output or OFF mode
to minimize the risk of inappropriate pacing. Exercise extreme caution during
ablation when in close proximity to atrial or ventricular permanent leads;
program the ICD to the OFF mode during the ablation procedure; and,
perform complete implantable device analysis on all patients after ablation.
20. Patients undergoing septal accessory pathway ablation are at risk for
complete AV block which requires the implantation of a permanent
pacemaker. Patients who experience inadvertent complete AV block as a
result of RF ablation may also require permanent pacing.
21. During the trans-aortic approach, adequate fluoroscopic visualization is
necessary to avoid placement of the catheter in the coronary vasculature.
Intracoronary placement of the ablation catheter, RF energy application,
or both have been associated with myocardial infarction.
22. Minimize X-ray exposure during the procedure. Catheter ablation
procedures present the potential for significant X-ray exposure, which can
result in acute radiation injury as well as increased risk for somatic and
genetic effects, to both patients and laboratory staff due to the X-ray beam
intensity and duration of the fluoroscopic imaging. Catheter ablation should
only be performed after adequate attention has been given to the potential
radiation exposure associated with the procedure, and steps have been
taken to minimize this exposure. Careful consideration must therefore be
given for the use of the device in pregnant women.
23. Do not expose catheter to organic solvents such as alcohol.
24. Do not autoclave the catheter.
25. Do not immerse proximal handle or cable connector in fluids; electrical
performance could be affected.
26. Do not scrub or twist the distal tip electrode during cleaning.
27. Inspect irrigation saline for air bubbles prior to its use in the procedure.
Air bubbles in the irrigation saline may cause emboli.
28. Purge catheter and irrigation tubing with heparinized normal saline.
29. Electrophysiology catheters and systems are intended for use only in X-ray
shielded rooms due to electromagnetic compatibility requirements and other
hospital safety guidelines.
30. Do not attempt to operate the Biosense Webster
T C
HERMO OOL
RF generator prior to completely reading and understanding the applicable
instructions for use.
31. Cardiac ablation procedures should be performed by appropriately trained
personnel in a fully equipped electrophysiology laboratory. Appropriate
clinical instruction in the use of the T
Bi-Directional Navigation Catheter should also be completed.
32. The long-term risks of protracted fluoroscopy and creation of RF induced
lesions have not been established. Careful consideration must therefore be
given for the use of the device in prepubescent children. Furthermore, the
risk/benefit in asymptomatic patients has not been studied.
33. When using the Biosense Webster T
Bi-Directional Navigation Catheter with conventional systems (using
fluoroscopy to determine catheter tip location), or with the C
Navigation System, careful catheter manipulation must be performed in
order to avoid cardiac damage, perforation, or tamponade. Catheter
advancement should be done under fluoroscopic guidance. Do not use
excessive force to advance or withdraw the catheter when resistance is
encountered. The firmness of the braided tip dictates that care must be
taken to prevent perforation of the heart. The contact force reading is for
information only and is not intended replace standard handling precautions.
34. Always place the Rocker Lever in the neutral position to straighten the
catheter tip before insertion or withdrawal of the catheter.
35. Always maintain a constant heparinized normal saline infusion to prevent
coagulation within the lumen of the catheter.
36. When RF current is interrupted for either a temperature or an impedance
rise (the set limit is exceeded), the catheter should be removed, and the tip
cleaned of coagulum, if present. When cleaning the tip electrode, be careful
not to twist the tip electrode with respect to the catheter shaft; twisting may
damage the tip electrode bond and loosen the tip electrode or may damage
the contact force sensor. A significant change in the baseline reading after
cleaning might indicate a damaged contact force sensor. Make sure the
irrigation holes are not plugged prior to re-insertion.
M-5276-785B
®
S T SF Bi-Directional Navigation Catheter or the
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