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(Circulation. 2006;113:1723-1729.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Effects of Gap Geometry on Conduction Through Discontinuous Radiofrequency Lesions

Francisco J. Pérez, MD; Mark A. Wood, MD; Christine M. Schubert, PhD

From the Department of Cardiology (F.J.P., M.A.W.) and Department of Biostatistics (C.M.S.), Virginia Commonwealth University Medical Center, Richmond, Va.

Correspondence to Mark Wood, MD, Box 980053, Virginia Commonwealth University Medical Center, Richmond, VA, 23298-0053. E-mail mwoodmd{at}pol.net

Received October 20, 2005; revision received January 27, 2006; accepted February 3, 2006.

Background— Gaps of sufficient cross-sectional dimensions within linear radiofrequency (RF) lesions may allow conduction through the lesion. The purpose of this study was to examine the effects of different gap geometries on conduction through discontinuous RF lesions.

Methods and Results— Radiofrequency lesions were created in isolated, perfused rabbit right ventricular (RV) free wall preparations to produce gaps with 3 different lesion geometries: straight, bifurcated, and angled (n=10 each group). Angled preparations contained 2 right angles within the conduction path. Optical mapping was used to assess bidirectional conduction through the myocardium before and after gap formation during pacing at 1000-, 400-, and 200-ms cycle lengths. Histological analysis was performed on each preparation after optical mapping. After lesion formation, 9 of 10 straight gap preparations and 1 of 10 angled gap preparations demonstrated bidirectional conduction (P<0.001) at all cycle lengths. Nine of 10 bifurcated gap preparations demonstrated bidirectional conduction and 1 demonstrated unidirectional conduction at all cycle lengths. Two bifurcated gap preparations showed rate-dependent unidirectional 2:1 conduction. All unidirectional and rate-dependent block occurred during impulse propagation in the direction of diverging arms of the bifurcation. The occurrence of bidirectional conduction in the gaps was associated with the gap geometry (P<0.0001). Histological analysis confirmed the continuity of viable myocardium transmurally throughout the length of the gap in each preparation. The sites of conduction block were demonstrated to be just after the first angle in the conduction path for angled gaps and at the branch point of a bifurcated gap. The predominant myofiber orientation was changed relative to the conduction path at angulations of the gaps. Flecainide (0.1 µmol/L) produced bidirectional conduction block in straight and bifurcated gap preparations with bidirectional conduction at baseline.

Conclusions— Conduction through discontinuities in RF lesions is associated with gap geometry. Complex gap geometry may allow for unidirectional and/or rate-dependent block. Gaps within RF lesions are susceptible to pharmacological blockade.

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