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Effect of Saline Irrigation Flow Rate on Temperature Profile during Cooled Radiofrequency Ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction: Cooled radiofrequency ablation has been developed clinically for the treatment of ventricular tachycardia. Although clinical studies employ a constant saline flow rate for cooling, we hypothesized that varying the flow rates might optimize the temperature profile at depth.

Methods: In excised ovine left ventricle, we compared the temperature profile from a catheter tip electrode thermocouple to those placed at depths of 0.0mm, 1.0mm, and 2.0mm. We compared the following settings: 20Watts without flow, 20Watts with 0.3cc/sec flow, 20Watts with 0.5cc/sec flow, and 70°C surface temperature without flow (temperature control).

Results: The temperatures decreased from 77.5±10.5°C, 91.7±6.3°C, 65.5±11.8°C, and 52.5±11.8°C at 20W without saline irrigation at the tip, 0.0mm, 1.0mm, and 2.0mm, respectively, to 33.0±1.4°C*, 63.4±7.0°C*, 57.1±5.8°C*, 49.9±5.8°C+ at 20W with 0.5ml/sec flow (*P<0.01, +P=0.09). The lesion volumes were 79.6mm3 for 20W without flow, 64.1mm3 for 20W with 0.3ml/sec flow, 47.5mm3 for 20W with 0.5ml/sec flow, and 28.6mm3 for temperature control.

Conclusions: We conclude that 1) the temperature profile greatly depends upon the rate of saline flow for cooling; 2) at high flow rates, the 0.0mm and 1.0mm temperatures are similar; 3) even at high irrigation rates, lesion size is greater than for temperature control; 4) the tip temperature significantly underestimates the surface temperature and improved methods of measuring temperature are needed.

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References

  1. Jackman WM, Wang X, Friday KJ, et al. Catheter ablation of accessory pathways (Wolf-Parkinson-White Syndrome) by radiofrequency current. N Engl J Med 1991;324:1605–1611.

    PubMed  Google Scholar 

  2. Kuck HK, Schlutter M, Geiger M, et al. Radiofrequency current catheter ablation of accessory pathways. Lancet 1991;337:1557–1561.

    PubMed  Google Scholar 

  3. Calkins H, Sousa J, El-Atassi R, et al. Diagnosis and cure of Wolf-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiological test. N Engl J Med 1991;324: 1612–1618.

    PubMed  Google Scholar 

  4. Kay GN, Epstein AE, Dailey SD, et al. Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia: evidence for the involvement of perinodal myocardium within the reentrant circuit. Circulation 1992;85: 1675–1688.

    PubMed  Google Scholar 

  5. Lesh MD, Van Hare GF, Schamp DJ, et al. Curative percutaneous catheter using radiofrequency ablation for accessory pathways in all locations: results in 100 consecutive patients. J Am Coll Cardiol 1992;19: 1303–1309.

    PubMed  Google Scholar 

  6. Morady F, Harvey M, Kalbfleisch SJ, et al. Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease. Circulation 1993;87:363–372.

    PubMed  Google Scholar 

  7. Avitall B, Khan M, Krum D, et al. Physics and engineering of transcatheter cardiac tissue ablation. J Am Coll Cardiol 1993;22:932–943.

    Google Scholar 

  8. Wang PJ, Estes NAM III. Physics and biology of catheter ablation. In: Singer I ed. Nonpharmacological therapy of arrhythmias for the 21st century: the state of the art. Armonk, NY: Futura; 1993:3–26.

    Google Scholar 

  9. Mittleman RS, Huang SKS, De Guzman WT, et al. Use of the saline infusion electrode catheter for improved energy delivery and increased lesion size in radiofrequency catheter ablation. PACE 1995;18:1022–1027.

    PubMed  Google Scholar 

  10. Skrumeda LL, Maguire MA, Mehra R. Effect of delivering saline at a low flow rate on RF lesion size in the left ventricle (Abstract). PACE 1995;18:921.

    Google Scholar 

  11. Nakagawa H, Yamanashi W, Wittkampf F, et al. Comparison of tissue temperature and lesion size in radiofrequency ablation using saline irrigation with a small versus large tip electrode in a canine thigh muscle preparation (Abstract). PACE 1995;18:917.

    Google Scholar 

  12. Ruffy R, Santel D, Whittaker P, et al. Radiofrequency delivery through an endocardial cooled catheter results in increased lesion size (Abstract). Circulation 1993;88(suppl 1):I–164.

    Google Scholar 

  13. Sykes C, Riley R, Pomeranz M, et al. Cooled tip ablation results in increased radiofrequency power delivery and lesion size (Abstract). PACE 1994;17:782.

    Google Scholar 

  14. Nakagawa H, Yamanashi WS, Pitha JV, et al: Comparison of in vivo tissue temperature proflle and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation. Circulation 1995;91:2264–2273.

    PubMed  Google Scholar 

  15. Ruffy R, Imran MA, Santel DJ, et al. Radiofrequency delivery through a cooled catheter tip allows the creation of larger endomyocardial lesions in the ovine heart. J Cardiovasc Electrophysiol 1995;6:1089–1096.

    PubMed  Google Scholar 

  16. Wharton JM, Nibley C, Sykes CM, et al. Establishment of a dose-response relationship for high power chilled-tip radiofrequency current ablation in sheep (Abstract). J Am Coll Cardiol 1995;Feb:293A.

  17. Nibley C, Sykes DM, Chapman T, et al. Prevention of impedance rise during radiofrequency current catheter ablation by intra-electrode tip chilling (Abstract). Circulation 1994;90:I–271.

    Google Scholar 

  18. Nibley C, Sykes CM, Rowan R, et al. Predictors of abrupt impedance rise during chilled-tip radiofrequency catheter ablation (Abstract). J Am Coll Cardiol 1995;Feb:293A.

  19. Nakagawa H, Khastgir T, Arruda M, et al. Radiofrequency catheter ablation using a saline irrigated electrode in patients with prior failed accessory pathway ablation (Abstract). PACE 1995;18:832.

    Google Scholar 

  20. Arruda M, Nakagawa H, Khastgir T, et al. Facilitation of accessory pathway ablation from the middle cardiac vein by a saline irrigated catheter electrode (Abstract). PACE 1995;18:832.

    Google Scholar 

  21. Nakagawa H, Yamanashi WS, Pitha JV, et al. Effective delivery of radiofrequency energy through the coronary sinus without impedance rise using a saline irrigated electrode (Abstract). J Am Coll Cardiol 1995;777A.

  22. Calkins H, Wharton JM, Epstein AE, et al. Safety and efficacy of catheter ablation of ventricular tachycardia using the cooled ablation system: final report (Abstract). PACE 1998;21:842.

    Google Scholar 

  23. Matsudaria K, Nakagawa H, Yamanashi WS, et al. Differential effects of saline irrigation flow rates on lesion depth and lesion volume (Abstract). PACE 1999;22:800.

    Google Scholar 

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Authors and Affiliations

  1. Cardiac Arrhythmia Service, New England Medical Center, Boston, MA

    Wai Shun Wong MD, Brian A. VanderBrink BS*, Mark S. Link MD, Munther K. Homoud MD, N.A. Mark Estes III MD & Paul J. Wang MD

  2. Cardiac Pathways Inc., Sunnyvale, CA

    Richard E. Riley MS & Mark Pomeranz MS

Authors
  1. Wai Shun Wong MD
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  2. Brian A. VanderBrink BS*
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  3. Richard E. Riley MS
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  4. Mark Pomeranz MS
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  5. Mark S. Link MD
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  6. Munther K. Homoud MD
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  7. N.A. Mark Estes III MD
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  8. Paul J. Wang MD
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Wong, W.S., VanderBrink BS*, B.A., Riley MS, R.E. et al. Effect of Saline Irrigation Flow Rate on Temperature Profile during Cooled Radiofrequency Ablation. J Interv Card Electrophysiol 4, 321–326 (2000). https://doi.org/10.1023/A:1009802721012

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  • DOI: https://doi.org/10.1023/A:1009802721012

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