Comparison of irrigated electrode designs for radiofrequency ablation of myocardium

被引:29
作者
Demazumder, D
Mirotznik, MS
Schwartzman, D
机构
[1] Allegheny Univ Hlth Sci, Electrophysiol Res Lab, Philadelphia, PA 19102 USA
[2] Catholic Univ Amer, Dept Elect Engn, Washington, DC 20064 USA
关键词
catheter ablation; radiofrequency; ablation; myocardium; irrigation;
D O I
10.1023/A:1013241927388
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Previous reports have demonstrated that radiofrequency energy delivered to myocardium via an irrigated electrode results in a more voluminous ablation lesion than a non-irrigated electrode. Different irrigated electrode designs have been utilized; no direct comparisons have been reported. Purpose: To compare different irrigated electrode designs. Methods: Three irrigation electrode designs were compared to a control (non-irrigated electrode) group: 1. internal; 2. showerhead; 3. sheath. For each electrode, prior to ablation Doppler echocardiographic assessment of the irrigant flow along the electrode outer surface was performed. Ablation was performed in vitro utilizing a whole blood-superfused system. Electrode, electrode-endocardial interface, and intramyocardial temperatures were assessed, as were ablation circuit impedance, total delivered energy, and lesion and electrode morphology. Room temperature normal saline was utilized as the irrigating fluid, delivered at 20 cc/min. Electrode-endocardial interfacial blood flow was assessed at rates of 0 and 0.26 m/s. Results. Irrigant was contained within the internal electrode design and therefore the electrode outer surface manifested no significant flow during irrigation. Irrigant spread primarily radially away from the showerhead electrode design, yielding relatively high electrode outer surface flow at the irrigation holes, but low elsewhere. Irrigant traveled in parallel to and enveloped the electrode outer surface of the sheath electrode design, yielding relatively moderate but uniform flow. Ablation via each of the irrigated electrodes yielded greater ablation energy deposition and larger lesion dimensions than the non-irrigated electrode. Irrigation did not necessarily prevent interfacial boiling, which could occur during uninterrupted radiofrequency energy deposition and lesion growth. The results for the 3 irrigation designs were incongruent. The duration of radiofrequency energy application via the internal electrode design was significantly shorter than the other designs, curtailed by impedance rise. This yielded the smallest total radiofrequency energy deposition and smallest ablation lesion volume. Relative to this, duration using the showerhead design was significantly longer, associated with greater total energy deposition and larger lesion volume. The sheath design permitted the longest duration, associated with the largest total energy deposition and lesion volume. Conclusions: Although each of the irrigated electrode designs yielded larger lesions than the non-irrigated electrode, they were not comparable. Ablation duration and lesion size were directly correlated with flow along the electrode outer surface.
引用
收藏
页码:391 / 400
页数:10
相关论文
共 13 条
[1]   Popping phenomena in temperature-controlled radiofrequency ablation: When and why do they occur? [J].
Eick, OJ ;
Gerritse, B ;
Schumacher, B .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2000, 23 (02) :253-258
[2]   Nonuniform heating patterns of commercial electrodes for radiofrequency catheter ablation [J].
Mirotznik, MS ;
Schwartzman, D .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1996, 7 (11) :1058-1062
[3]   USE OF THE SALINE INFUSION ELECTRODE CATHETER FOR IMPROVED ENERGY DELIVERY AND INCREASED LESION SIZE IN RADIOFREQUENCY CATHETER ABLATION [J].
MITTLEMAN, RS ;
HUANG, SKS ;
DEGUZMAN, WT ;
CUENOUD, H ;
WAGSHAL, AB ;
PIRES, LA .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1995, 18 (05) :1022-1027
[4]   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 [J].
NAKAGAWA, H ;
YAMANASHI, WS ;
PITHA, JV ;
ARRUDA, M ;
WANG, XZ ;
OHTOMO, K ;
BECKMAN, KJ ;
MCCLELLAND, JH ;
LAZZARA, R ;
JACKMAN, WM .
CIRCULATION, 1995, 91 (08) :2264-2273
[5]   3-DIMENSIONAL FINITE-ELEMENT ANALYSIS OF CURRENT-DENSITY AND TEMPERATURE DISTRIBUTIONS DURING RADIOFREQUENCY ABLATION [J].
PANESCU, D ;
WHAYNE, JG ;
FLEISCHMAN, SD ;
MIROTZNIK, MS ;
SWANSON, DK ;
WEBSTER, JG .
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, 1995, 42 (09) :879-890
[6]   Temperature-controlled irrigated tip radiofrequency catheter ablation: Comparison of in vivo and in vitro lesion dimensions for standard catheter and irrigated tip catheter with minimal infusion rate [J].
Petersen, HH ;
Chen, X ;
Pietersen, A ;
Svendsen, JH ;
Haunso, S .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1998, 9 (04) :409-414
[7]   Tissue temperatures and lesion size during irrigated tip catheter radiofrequency ablation: An in vitro comparison of temperature-controlled irrigated tip ablation, power-controlled irrigated tip ablation, and standard temperature-controlled ablation [J].
Petersen, HH ;
Chen, X ;
Pietersen, A ;
Svendsen, JH ;
Haunso, S .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2000, 23 (01) :8-17
[8]   Lower frequency (5 MHz) intracardiac echocardiography in a large swine model: Imaging views and research applications [J].
Ren, JF ;
Schwartzman, D ;
Michele, JJ ;
Li, KS ;
Hoffmann, J ;
Brode, SE ;
Lighty, GW ;
Dillon, SM ;
Chaudhry, FA .
ULTRASOUND IN MEDICINE AND BIOLOGY, 1997, 23 (06) :871-877
[9]   Radiofrequency delivery through a cooled catheter tip allows the creation of larger endomyocardial lesions in the ovine heart [J].
Ruffy, R ;
Imran, MA ;
Santel, DJ ;
Wharton, JM .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1995, 6 (12) :1089-1096
[10]  
Schwartzman D, 1998, CIRCULATION, V98, P567