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High Incidence of Thrombus Formation Without Impedance Rise During Radiofrequency Ablation Using Electrode Temperature Control
Author(s) -
MATSUDAIRA KAGARI,
NAKAGAWA HIROSHI,
WITTKAMPF FRED H.M.,
YAMANASHI WILLIAM S.,
IMAI SHINOBU,
PITHA JAN V.,
LAZZARA RALPH,
JACKMAN WARREN M.
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.t01-1-00173.x
Subject(s) - electrode , blood flow , medicine , biomedical engineering , materials science , thrombus , surgery , cardiology , chemistry
The authors hypothesized that during RF ablation, the electrode to tissue interface temperature may significantly exceed electrode temperature in the presence of cooling blood flow and produce thrombus. In 12 anesthetized dogs, the skin over the thigh muscle was incised and raised to form a cradle that was superfused with heparinized canine blood(ACT > 350 s)at 37°C. A 7 Fr, 4‐mm or 8‐mm ablation electrode containing a thermocouple was held perpendicular to the thigh muscle at 10‐g contact weight. Interface temperature was measured at opposite sides of the electrode using tiny optical probes. RF applications(n = 157)were delivered at an electrode temperature of 45°C, 55°C, 65°C, and 75°C for 60 seconds, with or without pulsatile blood flow (150 mL/min). Without blood flow, the interface temperature was similar to the electrode temperature. With blood flow, the interface temperature (side opposite blood flow) was up to 36°C and 57°C higher than the electrode temperature using the 4‐ and 8‐mm electrodes, respectively. After each RF, the cradle was emptied and the electrode and interface were examined. Thrombus developed without impedance rise at an interface temperature as low as 73°C without blood flow and 80°C with blood flow (11/16 RFs at 65°C electrode temperature using 4 mm and 13/13 RFs at an electrode temperature of 55°C using an 8‐mm electrode with blood flow). With blood flow, interface temperature markedly exceeded the electrode temperature and the difference was greater with an 8‐mm electrode (due to greater electrode cooling). In the presence of blood flow, thrombus occurred without an impedance rise at an electrode temperature as low as 65°C with a 4‐mm electrode and 55°C with an 8‐mm electrode. (PACE 2003; 26:1227–1237)