Nonuniform heating during radiofrequency catheter ablation with long electrodes: monitoring the edge effect.

BACKGROUND: Long, narrow electrodes are being considered for radiofrequency ablation of atrial fibrillation; however, preliminary work revealed coagulum formation on the electrodes and lack of lesion continuity. This may be due to the "edge effect," which concentrates radiated energy at sharp geometric gradients. It is proposed that temperature sensors at electrode edges are preferable to a single centered sensor for temperature feedback and monitoring of long electrode geometries. METHODS AND
RESULTS: A finite element model was used to predict the heating properties of new long electrode geometries. Sixteen dogs with atrial fibrillation underwent left and right atrial ablation using catheters with multiple 12.5-mm coil electrodes. Electrodes with a single thermistor were compared with electrodes with dual thermocouples placed at opposite ends and on opposing sides of the electrode. Power, temperature, and impedance were recorded for all lesions, and coagulum adhesion and magnitude were noted in a subset of lesions. Finite element analysis shows uneven heating, with the main heating concentrated at the electrode edges and a propensity toward temperatures >100 degrees C with single-thermistor feedback control. Ablations with dual thermocouple electrodes achieved higher measured temperatures at lower power levels than those that used single-thermistor electrodes. Impedance rises and coagulum adherence occurred less frequently with dual thermocouple electrodes than with single, centered thermistor electrodes (176 of 395 versus 9 of 425 lesions; P<.0001; 46 of 98 versus 7 of 150 lesions; P<.0001, respectively).
CONCLUSIONS: Maximum heating from radiofrequency energy occurs at the electrode edges, particularly with long electrodes. The safety of temperature-feedback atrial ablation with these electrodes is significantly improved by monitoring temperatures at the edges.