Cooled-tip ablation results in increased radiofrequency power delivery and lesion size in the canine heart: Importance of catheter-tip temperature monitoring for prevention of popping and impedance rise

Since myocardial lesion size during radio-frequency (RF) ablation is limited at high power by impedance rise when electrode tip temperature exceed 100 degreesC, controlling tip temperature by continuous intraelectrode saline infusion could permit generation of larger lesion. (1) Two dogs randomly received either standard or cooled tip RF ablation at 4 to 6 separate LV sites. Power output of 30 W was delivered via modified 7 Fr deflectable catheter with 4 mm tip for up to 120 sec or until impedance rise occurred. (2) Six dogs randomly received cooled tip RF ablation at power output of 20, 30, 40 W for 120 sec. (3) Three dogs randomly received cooled tip RF ablation using room temperature saline (21-25 degreesC) or chilled saline (1-4 degreesC) infusion. Results: Overall, peak tip temperature was lower for cooled vs standard RF deliveries (97+/-17 degreesC vs. 42+/-8 degreesC). Lesion depth and volume were significantly larger for cooled burns. Lesion depth and volume and the incidence of abrupt impedance rise/popping did not differ between room temperature saline and chilled saline infusion. The catheter-tip temperature at the onset of popping and abrupt impedance rise was 54+/-5 degreesC(48-60 degreesC) and 59+/-10 degreesC(50-75 degreesC). Conclusion: Cooled tip RF current delivery at high power is associated with increased myocardial lesion size which may facilitate successful ablation of ventricular tachycardia associated with acquired structural heart disease. Catheter-tip temperature should be maintained below 45 degreesC to prevent popping and abrupt impedance rise during RF energy delivery.