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Comparison of bipolar and unipolar radiofrequency ablation in an in vivo experimental model.

Abstract

OBJECTIVE

Linear atrial radiofrequency lesions have been used effectively for the treatment of atrial fibrillation. In most cases an endocardial approach has been suggested. A method for epicardial placement of lesions would reduce the complexity of these procedures. We compared lesions created in ovine hearts in vivo using irrigated bipolar or unipolar handheld radiofrequency ablation devices.

METHODS

Radiofrequency lesions were produced around a left pulmonary vein, around the left atrial appendage and in the free wall of the right ventricle in ovine hearts. All lesions were created in the beating heart. A bipolar clamping device (n = 7) or a handheld unipolar device (n = 6) was used. Measurements of local electrograms and pacing thresholds were performed before and after ablation at each site to assess the electrical integrity of lesions. Tetrazolium and digital image analysis were used to assess lesion geometry.

RESULTS

In atrial tissue continuous transmural lesions were achieved more often with the bipolar than with the unipolar device (92.3 vs. 33.3%, P < 0.02). In atrial tissue the reduction in signal amplitude caused by the lesions was significantly larger with the bipolar than the unipolar device (87.6+/-9.4% vs. 60.6+/-23.7% reduction, P < 0.01). There was a significant relationship between loss of pacing capture and lesion transmurality (P < 0.05). The bipolar device created narrower lesions than the unipolar device (4.1+/-0.9 mm vs. 5.9+/-2.1 mm, P < 0.001).

CONCLUSIONS

The bipolar clamping device produces narrower lesions which are more likely to be transmural and lead to electrical isolation of ablated tissue than those produced by the unipolar device. However, both devices failed to consistently produce transmural lesions using the epicardial beating heart technique studied, particularly in thicker tissues. High output pacing within the ablated tissue partially predicts lesion transmurality and be a guide to the need for further ablation. However, endocardial ablation or transmural bipolar ablation are likely to remain the techniques of choice for linear radiofrequency ablation in the atria until improved techniques are developed.

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    MeSH

    Animals
    Atrial Fibrillation
    Catheter Ablation
    Disease Models, Animal
    Electrocardiography
    Heart Atria
    Heart Ventricles
    Male
    Pericardium
    Pulmonary Veins
    Sheep

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    15982589