Comparison of bipolar and unipolar radiofrequency ablation in an in vivo experimental model

Objective: Linear atrial, radiofrequency lesions have been used effectively for the treatment of atrial fibrillation. Inmost cases an endocardial approach has been suggested. A method for epicardial placement of lesions would reduce the complexity of these procedures. We compared lesions created in ovine hearts in vivo using irrigated bipolar or unipolar handheld radiofrequency ablation devices. Methods: Radiofrequency lesions were produced around a left pulmonary vein, around the left atrial appendage and in the free wall of the right ventricle in ovine hearts. All lesions were created in the beating heart. A bipolar clamping device (n=7) ora handheld unipolar device (n-6) was used. Measurements of local etectrograms and pacing thresholds were performed before and after ablation at each site to assess the electrical integrity of lesions. Tetrazolium and digital image analysis were used to assess tesion geometry. Results: In atrial. tissue continuous transmural lesions were achieved more often with the bipolar than with the unipolar device (92.3 vs. 33.3%, P < 0.02). In atrial. tissue the reduction in signal amplitude caused by the lesions was significantly larger with the bipolar than the unipolar device (87.6 +/- 9.4% vs. 60.6 +/- 23.7% reduction, P < 0.01). There was a significant relationship between toss of pacing capture and lesion transmuratity (P < 0.05). The bipolar device created narrower lesions than the unipolar device (4.1 +/- 0.9 mm vs. 5.9 +/- 2.1 mm, P < 0.001). Conclusions: The bipolar clamping device produces narrower lesions which are more likely to be transmural and lead to electrical isolation of ablated tissue than those produced by the unipolar device. However, both devices failed to consistently produce transmural lesions using the epicardial beating heart technique studied, particularly in thicker tissues. High output pacing within the ablated tissue partially predicts tesion transmuratity and be a guide to the need for further ablation. However, enclocardial ablation or transmural bipolar ablation are likely to remain the techniques of choice for linear radiofrequency ablation in the atria until improved techniques are developed.