Comparison of a Saline Irrigated Cooled-Tip Catheter to Large Electrode Catheters with Single and Multiple Temperature Sensors for Creation of Large Radiofrequency Lesions

Abstract

Several catheter technologies for creating large radiofrequency (RF) lesions are used in clinical practice, but direct comparisons of the pathological lesions created by these technologies are unavailable. The purpose of this study was to compare the safety and efficacy of lesions created by three different large lesion RF ablation technologies. RF lesions were created in all four chambers of 15 mongrel dogs using 10 mm-tip multiple temperature sensor catheters, 10 mm tip single temperature sensor catheters, and 4 mm cooled-tip catheters. Pathological lesions were bisected, and measured after viability staining. A total of 242 (79 large-tip single sensor, 82 large-tip multiple sensor, and 81 cooled-tip) lesions were created. All atrial lesions were transmural but tended to have larger surface areas with the single thermistor large-tip catheter (73.4 +/- 24.8 mm2) compared to either the multithermistor large-tip (60.9 +/- 28.3 mm2) or the cooled-tip (61.9 +/- 28.5 mm2) catheters (p = 0.07), especially those in the IVC-TA isthmus. Depths and volumes of ventricular lesions created by the multiple-thermistor catheter (5.0 +/- 1.5 mm; 260 +/- 168 mm3) were smaller than either the single thermistor (5.7 +/- 1.5 mm; 428 +/- 290 mm3) or cooled-tip (6.1 +/- 1.8 mm; 403 +/- 217 mm3) catheters (p < 0.05). The difference in the depth and volume of lesions made by large-tip single thermistor and cooled-tip catheters was not significant. Char formation occurred during 11% of ablation with the single thermistor catheter, 6% with multithermistor and 8% of cooled-tip catheter (p = NS). There were no complications of ablation. All three catheters reliably created full thickness atrial lesions. For ventricular lesions, depths and volumes were similar for 10 mm-tip single thermistor and cooled-tip catheters. The multithermistor catheter lesions were smaller due to more precise temperature regulated power control. Safety was similar in all 3 groups.