Radiofrequency ablation of ventricular myocardium using active fixation and passive contact catheter delivery systems

This study examined the qualitative and quantitative effects of radiofrequency energy using active fixation and passive contact catheter delivery systems on normal bovine atrium and ventricle and diseased human ventricle in vitro. Two active fixation (custom screw-in or suction electrode) catheters and two passive contact (custom ring or standard electrode) catheters were used with a 500 kHz radiofrequency current generator. Linear regression analysis between lesion dimensions and power output showed excellent correlation coefficients for all catheter delivery systems except the suction catheter. Lesion sizes also increased with duration of radiofrequency energy delivery at low power using the USCI quadripolar catheter. Lesion size in diseased human ventricle was considerably smaller than in the normal ventricle. Comparison of induced lesion dimensions using pulsed and continuous delivery modes showed only minor differences. Tissue impedance was relatively constant during energy delivery. Arcing was associated with a sudden increase in voltage and impedance and a sudden decline in current. This was most frequently observed at high power and with the suction electrode catheter. The use of high (50 W) power output and prolonged application (up to 180 seconds) in atrium and ventricle did not induce perforation. We conclude that a variety of catheter delivery systems can be used for effective radiofrequency energy delivery and ablation in atrial and ventricular myocardium in the pulsed or continuous mode. Impedance changes during radiofrequency ablation cannot be used to guide the extent of ablation but do detect arcing during the procedure.