(Circulation. 1995;91:2264-2273.)
© 1995 American Heart Association, Inc.
Articles |
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
From the Cardiovascular Section/Department of Medicine, University of Oklahoma Health Sciences Center and the Department of Veterans Affairs Medical Center, Oklahoma City.
Correspondence to Warren M. Jackman, MD, Department of Medicine/Cardiovascular Section, University of Oklahoma Health Sciences Center, PO Box 26901, Rm 5SP300, Oklahoma City, OK 73190-3048.
Background It is thought that only a thin layer of tissue adjacent to the electrode is heated directly by electrical current (resistive heating) during radiofrequency ablation. Most of the thermal injury is thought to result from conduction of heat from the surface layer. The purpose of this study was to determine whether lesion depth could be increased by producing direct resistive heating deeper in the tissue with higher radiofrequency power, allowed by cooling the ablation electrode with saline irrigation to prevent the rise in impedance that occurs when the electrode-tissue interface temperature reaches 100°C.
Methods and Results In 11 anesthetized dogs, the thigh muscle was
exposed and bathed with heparinized canine blood (36°C to 37°C). A
7F catheter, with a central lumen, a 5-mm tip electrode with six
irrigation holes, and an internal thermistor, was positioned
perpendicular to the thigh muscle and held at a constant contact weight
of 10 g. Radiofrequency current was delivered to 145 sites (1) at high
constant voltage (66 V) without irrigation (CV group, n=31), (2) at
variable voltage (20 to 66 V) to maintain tip-electrode temperature at
80°C to 90°C without irrigation (temperature-control group,
n=39),
and (3) at high CV (66 V) with saline irrigation through the catheter
lumen and ablation electrode at 20 mL/min (CV irrigation group, n=75).
Radiofrequency current was applied for 60 seconds but was terminated
immediately in the event of an impedance rise 
10 
. Tip-electrode
temperature and tissue temperature at depths of 3.5 and 7.0 mm were
measured in all three groups (n=145). In 33 CV irrigation group
applications, temperature was also measured with a separate probe at
the center (n=18) or edge (n=15) of the electrode-tissue
interface. In
all 31 CV group applications, radiofrequency energy delivery was
terminated prematurely (at 11.6±4.8 seconds) owing to an impedance
rise associated with an electrode temperature of 98.8±2.1°C. All 39
temperature-control applications were delivered for 60 seconds without
an impedance rise, but voltage had to be reduced to 38.4±6.1 V to
avoid temperatures >90°C (mean tip-electrode temperature,
84.5±1.4°C). In CV irrigation applications, the tip-electrode
temperature was not >48°C (mean, 38.4±5.1°C) and the
electrode-tissue interface temperature was not >80°C (mean,
69.4±5.7°C). An abrupt impedance rise with an audible pop and
without coagulum occurred in 6 of 75 CV irrigation group applications
at 30 to 51 seconds, probably owing to release of steam from below the
surface. In the CV and temperature-control group applications, the
temperatures at depths of 3.5 (62.1±15.1°C and
67.9±7.5°C) and
7.0 mm (40.3±5.3°C and 48.3±4.8°C) were always lower
than the
electrode temperature. Conversely, in CV irrigation group applications,
electrode and electrode-tissue interface temperatures were consistently
exceeded by the tissue temperature at depths of 3.5 mm (94.7±9.1°C)
and occasionally 7.0 mm (65.1±9.7°C). Lesion dimensions were
smallest in CV group applications (depth, 4.7±0.6 mm; maximal
diameter, 9.8±0.8 mm; volume, 135±33 mm3),
intermediate
in temperature-control group applications (depth, 6.1±0.5 mm; maximal
diameter, 11.3±0.9 mm; volume, 275±55 mm3), and
largest
in CV irrigation group applications (depth, 9.9±1.1 mm; maximal
diameter, 14.3±1.5 mm; volume, 700±217 mm3;
P<.01, respectively).
Conclusions Saline irrigation maintains a low electrode-tissue interface temperature during radiofrequency application at high power, which prevents an impedance rise and produces deeper and larger lesions. A higher temperature in the tissue (3.5 mm deep) than at the electrode-tissue interface indicates that direct resistive heating occurred deeper in the tissue (rather than by conduction of heat from the surface).
Key Words: catheter ablation • radiofrequency • arrhythmia • tachycardia
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