High-Volume Lesions Using a New Second-Generation Open Irrigation Radiofrequency Catheter Are Associated with the Development of Inhomogeneous Lesions

Akca, F. and Hubay, Márta and Zima, Endre and Széplaki, Gábor and Végh, Eszter M. and Skopál, Judit and Lendvai, Zsuzsanna and Merkely, Béla and Szili-Török, Tamás (2014) High-Volume Lesions Using a New Second-Generation Open Irrigation Radiofrequency Catheter Are Associated with the Development of Inhomogeneous Lesions. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 37 (7). pp. 864-873. ISSN 0147-8389

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Abstract

BACKGROUND: After catheter ablation there is often a discrepancy between acute and chronic success rates. We aimed to evaluate major determinants for lesion quality and understand different manifestations of lesion structures. METHODS: In a canine thigh muscle model radiofrequency (RF) current was delivered for 60 seconds at 30 W (n = 39) or 50 W (n = 18) with 15-g contact force. A second-generation 12-hole gold open irrigation catheter (SGIT) and a first-generation six-hole platinum-iridium catheter (FGIT; Biotronik, Berlin, Germany) were used. Electrode and tissue temperatures (at the surface and 3.5-mm and 7-mm depth) were recorded and lesion dimensions were measured. Lesions with steam pops were excluded. Histological examination was performed to evaluate homogeneity of the lesions. Inhomogeneity was defined as a visual multiband lesion pattern indicating different histological characteristics. RESULTS: In total 57 lesions were created. Seventeen lesions were excluded (steam pops) and 40 lesions were analyzed. A total number of 11 homogeneous and 29 inhomogeneous lesions were identified. Using the SGIT catheter 16.7% of the lesions was homogeneous and 83.3% inhomogeneous; for FGIT it was 43.8% and 56.2% (P = 0.065), respectively. Homogeneous lesions had lower volumes as compared to inhomogeneous lesions (514.0 +/- 198.8 vs 914.8 +/- 399.1 mm, P = 0.003). Multiple logistic regression analysis indicated that the SGIT catheter is a significant predictor for inhomogeneous lesions (odds ratio 6.5, 95% confidence interval 1.1-38.8; P = 0.040) independent from power setting and flow rate. CONCLUSIONS: The development of inhomogeneous lesions after acute RF ablation is associated with higher lesion volumes and the use of the second-generation irrigation gold-tip catheter.

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