Skip to main content
SpringerLink
Log in

Cooled-Tip Ablation Results in Increased Radiofrequency Power Delivery and Lesion Size in the Canine Heart: Importance of Catheter-Tip Temperature Monitoring for Prevention of Popping and Impedance Rise

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Since myocardial lesion size during radio-frequency (RF) ablation is limited at high power by impedance rise when electrode tip temperature exceed 100 °C, controlling tip temperature by continuous intraelectrode saline infusion could permit generation of larger lesion. (1) Two dogs randomly received either standard or cooled tip RF ablation at 4 to 6 separate LV sites. Power output of 30 W was delivered via modified 7 Fr deflectable catheter with 4 mm tip for up to 120 sec or until impedance rise occurred. (2) Six dogs randomly received cooled tip RF ablation at power output of 20, 30, 40 W for 120 sec. (3) Three dogs randomly received cooled tip RF ablation using room temperature saline (21–25 °C) or chilled saline (1–4 °C) infusion.

Results: Overall, peak tip temperature was lower for cooled vs standard RF deliveries (97±17 °C vs. 42±8 °C). Lesion depth and volume were significantly larger for cooled burns. Lesion depth and volume and the incidence of abrupt impedance rise/popping did not differ between room temperature saline and chilled saline infusion. The catheter-tip temperature at the onset of popping and abrupt impedance rise was 54±5 °C(48–60 °C) and 59±10 °C(50–75 °C).

Conclusion: Cooled tip RF current delivery at high power is associated with increased myocardial lesion size which may facilitate successful ablation of ventricular tachycardia associated with acquired structural heart disease. Catheter-tip temperature should be maintained below 45 °C to prevent popping and abrupt impedance rise during RF energy delivery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Simmers TA, Wittkampf FHM, Hauer RNW, et al. In vivo ventricular lesion growth in radiofrequency catheter ablation. PACE 1994; 17: 523–531.

    PubMed  Google Scholar 

  2. Fitzgerald DM, Friday KJ, Yeung Lai Wah, et al. Myocardial regions of slow conduction participating in the reentrant circuit of multiple ventricular tachycardias: report on ten patient. J Cardiovasc Electrophysiol 1991; 2: 193–206.

    Google Scholar 

  3. 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 

  4. Kim YH, Sosa-Suarez G, Trouton TG, et al. Treatment of ventricular tachycardia by transcatheter radiofrequency ablation in patients with ischemic heart disease. Circulation 1994; 89: 1094–1102.

    PubMed  Google Scholar 

  5. Littmann L, Svenson RH, Gallagher JJ, et al. Functional role of the epicardium in postinfarction ventricular tachycardia: observations derived from computerized epicardial activation mapping, entrainment, and epicardial laser photoablation. Circulation 1991; 83: 1577–1591.

    PubMed  Google Scholar 

  6. Downer E, Kimber S, Harris L, et al. Endocardial mapping of ventricular tachycardia in the intact human heart, II: evidence for multisite reentry in a functional sheet of surviving myocardium. J Am Coll Cardiol 1992; 20: 869–878.

    PubMed  Google Scholar 

  7. Simmers TA, Wittkamp FHM, Hauer RNW, et al. In vivo ventricular lesion growth in radiofrequency catheter ablation. PACE 1994; 17: 523–531.

    PubMed  Google Scholar 

  8. Wittkamp FHM. Temperature response in radiofrequency catheter ablation. Circulation 1992; 86: 1648–1650.

    PubMed  Google Scholar 

  9. Ring ME, Huang SKS, Gorman Gey, et al. Determinants of impedance rise during catheter ablation of ventricular myocardium. Circulation 1990; 82: 1034–1038.

    PubMed  Google Scholar 

  10. Jackmann WM, Kuck KH, Naccareli GV, et al. Radiofrequency current directed across the mitral annulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs. Circulation 1988; 78: 1288–1298.

    PubMed  Google Scholar 

  11. Hains DE, Verow AF. Observations on electrodetissue interface temperature and effect on electrical impedance during radiofrequency ablation of ventricular myocardium. Circulation 1990; 82: 1034–1038.

    PubMed  Google Scholar 

  12. Wittkamp FHM, Hauer RN, Robles de Medina EO. Radiofrequency ablation with a cooled porous electrode catheter. J Am Coll Cardiol 1988; 11: 17 (abstract).

    Google Scholar 

  13. Huang SKS, Cuenoud H, Tan de Guzman W. Increase in the lesion size and decrease in the impedance rise with saline infusion electrode catheter for radiofrequency catheter ablation. Circulation 1989; 80: II-324 (abstract).

    Google Scholar 

  14. Bergau D, Brucker GG, Saul JP. Porous metaltipped catheter produces larger radiofrequency lesions through tip cooling. Circulation 1993; 88: I-64 (abstract).

    Google Scholar 

  15. Nakagawa H, Yamanashi WS, Pitha JV, et al. 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.

    PubMed  Google Scholar 

  16. Nibley C, Sykes CM, Chapman T, et al. Prevention of impedance rise during radiofrequency current catheter ablation by intra-electrode tip cooling. Circulation 1994; 90: I-271 (abstract).

    Google Scholar 

  17. Ring ME, Huang SKS, Gorman G, et al. Determinants of impedance rise during catheter ablation of bovine myocardium with radiofrequency energy. PACE 1898; 12: 1502–1513.

    Google Scholar 

  18. Langberg JJ, Calkins H, El-Atassi R, et al. Temperature monitoring during radiofrequency catheter ablation of accessory pathways. Circulation 1992; 86: 1464–1474.

    PubMed  Google Scholar 

  19. 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 

  20. 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 

  21. Nibley C, Sykes CM, Rowan R, et al. Predictors of abrupt impedance rise during chilled-tip radiofrequency catheter abrupt impedance rise during chilledtip radiofrequency catheter ablation. JAmColl Cardiol 1995; Feb:293A (abstract).

  22. Wharton JM, Nibley C, Sykers, et al. Establishment of a dose-response relationship for higher power chilledtip radiofrequency current ablation in sheep. J AmColl Cardiol 1995;Feb:293A (abstract).

  23. Skrumeda LL, Mehra R. Comparison of standard and irrigated radiofrequency ablation in the canine ventricle. J Cardiovasc Electrophysiol 1998; 9: 1196–1205.

    PubMed  Google Scholar 

  24. Petersen HH, Chen X, Petersen A, et al. Tissue temperature and lesion size during irrigated tip catheter radiofrequency ablation. PACE 200; 23: 8–17.

  25. Calkins H, Epstein A, Packer D, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy. JAm Coll Cardiol 2000; 35: 1905–1914.

    Google Scholar 

  26. Petersen HH, Chen X, Petersen A, et al. Temperaturecontrolled irrigated radiofrequency catheter ablation: comparison of in vivo and in vitro lesion dimensions for standard and irrigated tip catheter with minimal infusion rate. J Cardiovasc Electrophysiol 1998; 9: 409–414.

    PubMed  Google Scholar 

  27. Nakagawa H, Wittkampf FHM, Yamanashi WS, et al. Inverse relationship between electrode size and lesion size during radiofrequency ablation with active electrode cooling. Circulation 1998; 98: 458–465.

    PubMed  Google Scholar 

  28. Jais P, Haissaguerre M, Shah DC, et al. Successful irrigated-tip catheter ablation of atrial flutter resistant to conventional radiofrequency ablation.

  29. Jais P, Shah DC, Haissaguerre M, et al. Prospective randomized comparison of irrigated-tip versus conventional-tip catheters for ablation of common flutter. Circulation 2000; 101: 772–776.

    PubMed  Google Scholar 

  30. Wong WS, VanderBrink BA, Riley RE, et al. Effect of saline irrigation flow rate on temperature profile during radiofrequency ablation. J Intervent Cardiac Electrophysiol 2000; 4: 321–326.

    Google Scholar 

  31. Delacretaz E, Stevenson WG, Winters GL, et al. Ablation of ventricular tachycardia with a saline-cooled radiofrequency catheter: anatomic and histologic characteristic of the lesions in humans. J Cardiovasc Electrophysiol 1999; 10: 860–865.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Second Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kami, Itabashi-Ku, Tokyo, Japan, 173-8610

    Ichiro Watanabe, Riko Masaki, Nuo Min, Naohiro Oshikawa, Kimie Okubo, Hidezou Sugimura, Toshiaki Kojima, Satoshi Saito, Yukio Ozawa & Katsuo Kanmatsuse

Authors
  1. Ichiro Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riko Masaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nuo Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naohiro Oshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kimie Okubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hidezou Sugimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshiaki Kojima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Satoshi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yukio Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Katsuo Kanmatsuse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ichiro Watanabe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Watanabe, I., Masaki, R., Min, N. et al. Cooled-Tip Ablation Results in Increased Radiofrequency Power Delivery and Lesion Size in the Canine Heart: Importance of Catheter-Tip Temperature Monitoring for Prevention of Popping and Impedance Rise. J Interv Card Electrophysiol 6, 9–16 (2002). https://doi.org/10.1023/A:1014140104777

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1014140104777

Search

Navigation