INTRODUCTION: The aim of this study is to characterize ablation lesions using varying ratios of bipolar:unipolar energy and to show the feasibility of a circular decapolar pulmonary vein ablation catheter (PVAC) to create transmural lesions in an in vivo porcine superior vena cava (SVC) model. METHODS AND RESULTS: Ablations were performed on (1) isolated blocks of bovine myocardium, (2) thigh muscle preparations (4 pigs), and (3) the junction between SVC and right atrium (6 pigs). Radiofrequency (RF) energy was delivered simultaneously to all electrodes (target temperature 60 degrees C, maximum power 10 W/electrode) with various ratios of bipolar:unipolar energy. (1) In vitro PVAC resulted in circumscript lesions. Changing RF energy mode from unipolar only to bipolar:unipolar 1:1, 2:1 and 4:1 and bipolar only decreased lesion depth significantly (6.7 +/- 0.2 vs. 5.0 +/- 0.2, 4.1 +/- 0.3, 3.6 +/- 0.1 and 3.1 +/- 0.1 mm, P < 0.001). (2) Similar results were obtained in vivo (thigh muscle) showing less deep lesions with more bipolar energy modes (e.g., 5.4 +/- 1.3 for unipolar only vs. 4.1 +/- 0.8 mm for bipolar only, P < 0.05). (3) Ablation at the SVC did not result in device-related complications. All animals survived and were sacrificed after 7 +/- 1 days except for one pig, which died immediately postoperatively from an unknown cause. Macroscopy and microscopy showed circumferential transmural SVC lesions. CONCLUSIONS: Temperature-controlled, power-limited RF energy with the PVAC is feasible for creating circumferential transmural lesions (SVC) that sometimes extended to neighboring structures. Lesion depth can be titrated by varying the bipolar:unipolar energy ratio. This novel ablation system paves the way for single-catheter ablation of AF.
INTRODUCTION: The aim of this study is to characterize ablation lesions using varying ratios of bipolar:unipolar energy and to show the feasibility of a circular decapolar pulmonary vein ablation catheter (PVAC) to create transmural lesions in an in vivo porcine superior vena cava (SVC) model. METHODS AND RESULTS: Ablations were performed on (1) isolated blocks of bovine myocardium, (2) thigh muscle preparations (4 pigs), and (3) the junction between SVC and right atrium (6 pigs). Radiofrequency (RF) energy was delivered simultaneously to all electrodes (target temperature 60 degrees C, maximum power 10 W/electrode) with various ratios of bipolar:unipolar energy. (1) In vitro PVAC resulted in circumscript lesions. Changing RF energy mode from unipolar only to bipolar:unipolar 1:1, 2:1 and 4:1 and bipolar only decreased lesion depth significantly (6.7 +/- 0.2 vs. 5.0 +/- 0.2, 4.1 +/- 0.3, 3.6 +/- 0.1 and 3.1 +/- 0.1 mm, P < 0.001). (2) Similar results were obtained in vivo (thigh muscle) showing less deep lesions with more bipolar energy modes (e.g., 5.4 +/- 1.3 for unipolar only vs. 4.1 +/- 0.8 mm for bipolar only, P < 0.05). (3) Ablation at the SVC did not result in device-related complications. All animals survived and were sacrificed after 7 +/- 1 days except for one pig, which died immediately postoperatively from an unknown cause. Macroscopy and microscopy showed circumferential transmural SVC lesions. CONCLUSIONS: Temperature-controlled, power-limited RF energy with the PVAC is feasible for creating circumferential transmural lesions (SVC) that sometimes extended to neighboring structures. Lesion depth can be titrated by varying the bipolar:unipolar energy ratio. This novel ablation system paves the way for single-catheter ablation of AF.
Authors: J C Balt; S Karadavut; A A W Mulder; J G L M Luermans; M C E F Wijffels; L V A Boersma Journal: J Interv Card Electrophysiol Date: 2013-05-01 Impact factor: 1.900