Abstract
Background: Radiofrequency catheter ablation of atrial flutter, atrial fibrillation or ventricular tachycardia may be favoured by large lesions. We compared lesions created in unipolar mode using 10-mm/8 F electrodes with those of 4-mm/7 F catheters.
Methods: Ablations were first performed in porcine hearts in vitro (70°C, 60 s, tangential catheter tip-tissue orientation). Anaesthetized pigs were thereafter ablated with 10- or 4-mm catheters in the right atrial free wall (RAFW), inferior vena cava-tricuspid valve (IVC-TV) isthmus and left ventricle (LV).
Results: In vitro, lesion length doubled and lesion volume tripled using the 10-mm catheter. Average power supply was 69 (SD12) (10-mm tip) versus 26 (SD7) W (4-mm tip). In vivo, lesion length increased by 50% and lesion volume fivefold. Charring at the lesion surface or sudden impedance rises were not observed in vivo. Histologically, coagulation necrosis and minor haemorrhages were found. One RAFW lesion (10-mm) showed a dissection approaching the epicardium. Fibrinous platelet clots or overt thromboses covered the endocardial surface in half of all lesions. Three 10-mm electrode isthmus lesions extended to the right descending posterior artery and one LV lesion to the left anterior descending artery, but there was no damage to the arterial walls. Following six ablations with the 10-mm electrode and two with the 4-mm tip, injury to the adjacent lung tissue of 0.5 to 6.0 mm depth was found (p = 0.22).
Conclusion: RF ablation using 10-mm/8 F electrodes created significantly larger lesions. 10-mm electrodes appeared safe in the porcine IVC-TV isthmus and LV, but not in the RAFW.
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References
Cosio FG, Lopez-Gil M, Goicolea A, Arribas F, Barroso JL. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993;71:705–709.
Nakagawa H, Lazzara R, Khastgir T, Beckman KJ, McClelland JH, Imai S, Pitha JV, Becker AE, Arruda M, Gonzalez MD, et al. Role of the tricuspid annulus and the Eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation 1996;94:407–424.
Stevenson WG, Sager PT, Natterson PD, Saxon LA, Middlekauff HR, Wiener I. Relation of pace mapping QRS configuration and conduction delay to ventricular tachycardia reentry circuits in human infarct scars. J Am Coll Cardiol 1995;26:481–488.
Wilber DJ, Burke MC,Kall JG, Verdino RJ, Kopp DE. Longterm outcome of catheter ablation for postinfarct ventricular tachycardia. [Abstract]. Circulation 1997;96:I–318.
Anfinsen OG, Kongsgaard E, Foerster A, Amlie JP, Aass H. Bipolar radiofrequency catheter ablation creates confluent lesions at larger interelectrode spacing than does unipolar ablation from two electrodes in the porcine heart. Eur Heart J 1998;19:1075–1084.
Langberg JJ, Gallagher M, Strickberger SA, Amirana O. Temperature-guided radiofrequency catheter ablation with very large distal electrodes. Circulation 1993;88:245–249.
Langberg JJ, Lee MA, Chin MC, Rosenqvist M. Radiofrequency catheter ablation: The effect of electrode size on lesion volume in vivo. PACE 1990;13:1242–1248.
Haines DE, Watson DD, Verow AF. Electrode radius predicts lesion radius during radiofrequency energy heating. Validation of a proposed thermodynamic model. Circ Res 1990;67:124–129.
Mittleman RS, Huang SK, de Guzman WT, Cuenoud H, Wagshal AB, Pires LA. Use of the saline infusion electrode catheter for improved energy delivery and increased lesion size in radiofrequency catheter ablation. PACE 1995;18:1022–1027.
Ruffy R, Imran MA, Santel DJ, Wharton JM. 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.
Nakagawa H, Yamanashi WS, Pitha JV, Arruda M, Wang X, Ohtomo K, Beckman KJ, McClelland JH, Lazzara R, Jackman WM. Comparison of in vivo tissue temperature profile 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.
Chen SA, Tai CT, Yu WC, Chen YJ, Ding YA, Chang MS. Is 8 mm really more effective than 4 mm tip-ablation catheter for ablation of atrial flutter? [Abstract]. Circulation 1998;98:I-19.
Mehdirad A, Gaiser J, Baker P, West S, Lehmkuhl L, Yong P, Meimer J, Nelson S. Effect of catheter tip length and position on lesion volume in temperature controlled RF ablation in canine tricuspid valve annulus. J Intervent Cardiac Electrophysiol 1998;2:279–284.
Anfinsen OG, Kongsgaard E, Foerster A, Aass H, Amlie JP. Radiofrequency current ablation of porcine right atrium: Increased lesion size within bipolar two catheter technique compared to unipolar application in vitro and in vivo. PACE 1998;21:69–78.
Hoyt RH, Huang SK, Jordan N, Marcus F. Factors influencing transcatheter radiofrequency ablation of the myocardium. [Abstract]. Circulation 1987;72:III-473.
Haines DE, Watson DD. Tissue heating during radiofrequency catheter ablation: A thermodynamic model and observations in isolated perfused and superfused canine right ventricular free wall. PACE 1989;12:962–976.
Satake S, Okishige K, Azegami K, Sasano T. Transmural ablation of the atrial tissue using an irrigated tip electrode with monitoring the electrogram at the ablation site. [Abstract]. Circulation 1997;96:I-576.
Johnson S. Impact of ablation location on impedence pop occurrence with irrigated tip energy delivery in dogs. [Abstract]. Circulation 1997;96:I-576.
Kongsgaard E, Foerster A, Aass H, Madsen S, Amlie JP. Power and temperature guided radiofrequency catheter ablation of the right atrium in pigs. PACE 1994;17:1610–1620.
Haines DE. The biophysics of radiofrequency catheter ablation in the heart: The importance of temperature monitoring. PACE 1993;16:586–591.
Paul T, Bokenkamp R, Mahnert B, Trappe HJ. Coronary artery involvement early and late after radiofrequency current application in young pigs.Am Heart J 1997;133:436–440.
Solomon AJ, Tracy CM, Swartz JF, Reagan KM, Karasik PE, Fletcher RD. Effect on coronary artery anatomy of radiofrequency catheter ablation of atrial insertion sites of accessory pathways. J Am Coll Cardiol 1993;21:1440–1444.
Strickberger SA, Okishige K, Meyerovitz M, Shea J, Friedman PL. Evaluation of possible long-term adverse consequences of radiofrequency ablation of accessory pathways. Am J Cardiol 1993;71:473–475.
Lesh MD, Van Hare GF, Schamp DJ, Chien W, Lee MA, Griffin JC, Langberg JJ, Cohen TJ, Lurie KG, Scheinman MM. Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: results in 100 consecutive patients. J Am Coll Cardiol 1992;19:1303–1309.
Hope EJ, Haigney MC, Calkins H, Resar JR. Left main coronary thrombosis after radiofrequency ablation: Successful treatment with percutaneous transluminal angioplasty. Am Heart J 1995;129:1217–1219.
Pons M, Beck L, Leclercq F, Ferriere M, Albat B, Davy JM. Chronic left main coronary artery occlusion: A complication of radiofrequency ablation of idiopathic left ventricular tachycardia. PACE 1997;20:1874–1876.
Philippon F, Plumb VJ, Epstein AE, Kay GN. The risk of atrial fibrillation following radiofrequency catheter ablation of atrial flutter. Circulation 1995;92:430–435.
Fischer B, Haissaguerre M, Garrigues S, Poquet F, Gencel L, Clementy J, Marcus FI. Radiofrequency catheter ablation of common atrial flutter in 80 patients. J Am Coll Cardiol 1995;25:1365–1372.
Cauchemez B, Haissaguerre M, Fischer B, Thomas O, Clementy J, Coumel P. Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 1996;93:284–294.
Chen SA, Chiang CE, Wu TJ, Tai CT, Lee SH, Cheng CC, Chiou CW, Ueng KC, Wen ZC, Chang MS. Radiofrequency catheter ablation of common atrial flutter: Comparison of electrophysiologically guided focal ablation technique and linear ablation technique. J Am Coll Cardiol 1996;27: 860–868.
Lesh MD, Van Hare GF, Epstein LM, Fitzpatrick AP, Scheinman MM, Lee RJ, Kwasman MA, Grogin HR, Griffin JC. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation 1994;89:1074–1089.
Tabuchi T, Okumura K, Matsunaga T, Tsunoda R, Jougasaki M, Yasue H. Linear ablation of the isthmus between the inferior vena cava and tricuspid annulus for the treatment of atrial flutter. A study in the canine atrial flutter model. Circulation 1995;92:1312–1319.
Kongsgaard E, Steen T, Jensen O, Aass H, Amlie JP. Temperature guided radiofrequency catheter ablation of myocardium: Comparison of catheter tip and tissue temperatures in vitro. PACE 1997;20:1252–1260.
McRury ID, Whayne JG, Haines DE. Temperature measurement as a determinant of tissue heating during radiofrequency catheter ablation: An examination of electrode thermistor positioning for measurement accuracy. J Cardiovasc Electrophysiol 1995;6:268–278.
Anfinsen OG, Kongsgaard E, Aass H, Amlie JP. Radiofrequency catheter ablation in vitro: The difference between tissue and catheter tip temperature depends on location of the temperature sensor. Eur JCPE 1996;6:195–203.
Hahn N, Popov-Cenic S, Dorer A. Basic values of blood coagulation parameters in pigs (Sus scrofa domesticus). Berliner und Munchener TierarztlicheWochenschrift 1996;109: 23–27.
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Anfinsen, OG., Aass, H., Kongsgaard, E. et al. Temperature-Controlled Radiofrequency Catheter Ablation with a 10-mm Tip Electrode Creates Larger Lesions without Charring in the Porcine Heart. J Interv Card Electrophysiol 3, 343–351 (1999). https://doi.org/10.1023/A:1009840004782
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DOI: https://doi.org/10.1023/A:1009840004782