Comparison of irrigated electrode designs for radiofrequency ablation of myocardium.

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.