Pulsing microwave energy: a method to create more uniform myocardial temperature gradients

Microwave energy has been proposed as a possible technique to create large myocardial lesions. Achieving a uniform myocardial temperature gradient during microwave ablation may prevent excessive endocardial temperatures while maintaining temperatures at depth. The goal of the current study was to examine the ability of microwave (MW) pulsing to achieve a more uniform myocardial temperature gradient. Using an in-vitro ovine endocardial model, we measured tissue temperature at 0.5-mm, 2.0-mm, and 3.5-mm depths in a circulating saline bath. MW energy was delivered at 20 W at 915 MHz for 30 seconds. Pulse configurations of 1 second on-1 second off, 3 seconds on-3 seconds off, and 5 seconds on-5 seconds off, with 30 seconds of total MW time were compared with 30-seconds continuous. Maximum temperatures at 0.5 mm were significantly lower at 63.2 +/- 5.89 degrees C for the 1-second pulse compared with 83.5 +/- 7.31 degrees C for the continuous-energy delivery. Pulse configurations 3 seconds on-3 seconds off and 5 seconds on-5 seconds off also resulted in a significantly lower surface temperature than continuous-energy delivery. However, temperature at the 2.0-mm and 3.5-mm depth created by the pulsing delivery were similar to those achieved during continuous-energy delivery. Thus, microwave pulsing achieves a lower endocardial temperature and results in a more uniform temperature gradient. These techniques may prevent the excessive endocardial damage that may result in an increased risk of thrombus formation and embolization.