Radiofrequency catheter ablation with the split-tip electrode in the temperature-controlled mode.

Abstract

The 7 Fr "split-tip electrode" (2.5-mm tip electrode divided longitudinally into four electrodes with an adjacent 2-mm ring electrode) improves mapping resolution due to its small recording electrodes and narrow interelectrode distances (0.1 mm). The purpose of this study was to examine the temperature-controlled ablation properties of this electrode. In seven anesthetized dogs, the thigh muscles were exposed and superfused with canine blood. A split-tip catheter electrode (with a thermocouple in each of the five electrodes) and a conventional 4-mm catheter electrode were positioned at constant pressure perpendicular or parallel to the surface of the thigh muscle. Impedance measured between each split electrode and a skin patch correlated with the degree of contact with blood and tissue. In the parallel catheter to tissue orientation, split electrodes not in contact with tissue had a low impedance (mean 210-224 ohms), and the split electrode almost entirely in contact with tissue had the highest impedance (380 +/- 56 ohms). In the perpendicular catheter to tissue orientation all split electrodes had a similar impedance (mean 279-286 ohms). A total of 75 radiofrequency (RF) lesions were produced in the temperature-controlled mode with the 4-mm electrode (target 60 degrees C) or the split-tip electrode (power limited by the hottest electrode reaching 70 degrees C) with current delivered to all five electrodes simultaneously, or only to electrodes in contact with tissue. Lesion depth was not significantly different between electrodes in the parallel orientation (5.2 +/- 0.9 vs 5.1 +/- 1.4 vs 5.3 +/- 1.1 mm), but significantly deeper with the conventional 4-mm tip electrode in the perpendicular orientation (6.7 +/- 1.2 vs 5.3 +/- 1.3 vs 5.6 +/- 0.9 mm, P < 0.05). This was due to higher power delivered to the conventional 4-mm electrode (27 +/- 9 vs 17 +/- 7 vs 15 +/- 7 W, P < 0.05) because convective cooling by the blood flow was less effective for the split-tip electrode due to a reduced heat conduction across the interelectrode space from the hottest electrode to cooler areas of the group of five electrodes (mean temperature difference between the hottest split electrodes and the ring electrode: 24 degrees C). Electrode cooling or heat conduction was not effected by the elimination of current delivery to non-contact electrodes. Steam pops occurred in 36% of applications with the conventional 4-mm electrode in the perpendicular orientation but never with the split-tip electrode in spite of the higher target temperature. Measurement of impedance from the split electrodes allow the determination of electrode tissue contact and RF lesions produced with the split-tip electrode in the temperature-controlled mode using a target of 70 degrees C were of reasonable size and not associated with steam pops.