Abstract
Purpose
Return electrode burns occur occasionally in cardiac radiofrequency ablation and more frequently in tumor radiofrequency ablation. A return electrode incorporating a thermochromic liquid crystal (TLC) layer, which changes color with temperature, has been shown in sheep studies to accurately indicate underlying skin temperature. We aimed to validate the accuracy of TLC-coated return electrodes in indicating skin temperature in the clinical setting of cardiac radiofrequency ablation.
Methods and results
The top layer of a standard return electrode was replaced with TLC. Fluoro-optic thermometer (FOT) probes were laid on the skin side of the return electrode, which was then placed on the left lateral mid-thigh of 18 patients (mean age = 61 ± 12 years, 12 men) undergoing cardiac radiofrequency ablation. Return electrode photographs were taken when FOT temperature exceeded 35 °C. TLC color changes, observed in 11 patients, were converted to temperature and compared with FOT temperature. TLC temperature correlated well with FOT temperature (Pearson’s coefficient = 0.97 ± 0.03). Bland–Altman analysis showed good agreement (mean temperature difference = −0.04 ± 0.08 °C, upper limit of agreement = 0.11 ± 0.005 °C, lower limit of agreement = −0.19 ± 0.005 °C). The maximum FOT temperature recorded was 39.6 °C. There was no thermal injury at the return electrode site on any patients, when assessed immediately after and the day following the procedure.
Conclusion
TLC-coated return electrodes accurately indicate underlying skin temperature in cardiac radiofrequency ablation and may help prevent burns. This technology might be essential in high energy radiofrequency ablation.
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Acknowledgments
We would like to thank all the patients that participated in the study and the catheter laboratory and nursing staff for their assistance throughout the study.
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The Sydney West Area Health Service (SWAHS) has patented this technology. Dr. Thiagalingam, Mr. Barry, Dr. Ross, and Dr. Kovoor are listed as co-inventors.
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Trivedi, S.J., Lim, T.W., Barry, M.A. et al. Clinical evaluation of a new technique to monitor return electrode skin temperature during radiofrequency ablation. J Interv Card Electrophysiol 36, 307–314 (2013). https://doi.org/10.1007/s10840-012-9750-x
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DOI: https://doi.org/10.1007/s10840-012-9750-x