Lesion size in relation to ablation site during radiofrequency ablation

This study was designed to investigate the effect of the convective cooling of the tip of the ablation electrode during temperature controlled radiofrequency ablation. In vivo two different application sites in the left ventricle of anaesthetised pigs were ablated and in vitro ablation was performed during two different flow-velocities in a tissue bath, while electrode contact pressure and position were unchanged. Target temperature was 80 degrees C. Obtained tip temperature, power consumption and lesion dimensions were measured. In vivo lesion volume, depth and width were found significantly larger for septal applications than apical applications (p < 0.01) and more power was used (p < 0.001). Obtained tip temperature was significantly lower in the septal applications (p < 0.001). In vitro increased convective cooling by induction of flow yielded larger lesion volume, depth and width (p < 0.01), and had higher power consumptions (p < 0.01). Obtained tip temperature did not differ significantly. For the given chosen target temperature power consumption was positively related to lesion volume (r = 0.66 in vivo and 0.65 in vitro), whereas obtained tip temperature was not (r = -0.49 in vivo and -0.61 in vitro). We conclude that during temperature controlled radiofrequency ablation lesion size differs for septal and apical left ventricular applications. Differences in convective cooling might play an important role in this respect. This is supported by our in vitro experiments, where increased convective cooling by induction of a flow around the electrode tip increases lesion dimensions and power consumptions. Furthermore we conclude that for the given target temperature the power consumption is positively correlated with lesion volume (p < 0.001), whereas the obtained tip temperature is not.