Published Online
on December 27, 2005

A more recent version of this article appeared on January 3, 2006

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Submitted on December 30, 2004
Revised on October 10, 2005
Accepted on October 13, 2005

Comparison of Electrode Cooling Between Internal and Open Irrigation in Radiofrequency Ablation Lesion Depth and Incidence of Thrombus and Steam Pop

Katsuaki Yokoyama MD, PhD, Hiroshi Nakagawa MD, PhD^*, Fred H.M. Wittkampf PhD, Jan V. Pitha MD, PhD, Ralph Lazzara MD, and Warren M. Jackman MD

From the Cardiac Arrhythmia Research Institute, Departments of Medicine (K.Y., H.N., R.L., W.J.M.) and Pathology (J.V.P.), University of Oklahoma Health Sciences Center and Veterans Administration Medical Center, Oklahoma City, Okla; and Heart Lung Center, Utrecht, the Netherlands (F.H.M.W.).

^* To whom correspondence should be addressed. E-mail: hiroshi-nakagawa{at}ouhsc.edu.

Background--Electrode cooling by circulating fluid within the electrode (closed loop) or open irrigation facilitates radiofrequency (RF) ablation. This study compared lesion parameters between closed loop and open irrigation with the use of a canine model.

Methods and Results--In 8 anesthetized dogs, the skin over the thigh muscle was incised and raised, forming a cradle superfused with heparinized blood (activated clotting time >350 seconds) at 37°C. A 7F 4-mm closed loop electrode (irrigation 36 mL/min) and 7.5F 3.5-mm open irrigation electrode (irrigation 17 mL/min) were positioned perpendicular to the thigh muscle at 10 g contact weight. RF was applied (n=121) at 20 or 30 W for 60 seconds in low (0.1 m/s) or high (0.5 m/s) pulsatile blood flow. Temperatures were measured in the electrode, electrode-tissue interface, and within the tissue at 3- and 7-mm depths. After each RF, the cradle was emptied to examine the electrode and interface for thrombus. There was no difference between closed loop and open irrigation in impedance, lesion depth, or tissue temperature at 20 or 30 W. Interface temperature and electrode temperature were greater in the closed loop application. Thrombus occurred in 32 of 63 closed loop versus 0 of 58 open irrigation RF applications (P<0.05) with interface temperature 80°C in all 32 (electrode temperature <40°C in 1, 40°C to 50°C in 26, and >50°C in 5). With closed loop, interface temperature and thrombus incidence were greater at 30 W and low blood flow. With open irrigation, interface temperature remained low (71°C) with no difference between 20 and 30 W or between low and high blood flow. Steam pop occurred at 20 W in 4 of 35 closed loop and 0 of 30 open irrigation and at 30 W in 15 of 28 closed loop and 4 of 28 open irrigation applications (P<0.05).

Conclusions--Lower interface temperature, thrombus, and steam pop, especially in low blood flow, indicate greater interface cooling with open irrigation.

Key words: catheter ablation • radiofrequency • tachyarrhythmias • thrombus

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