Power Vs. Temperature-Guided Radiofrequency Ablation

August 01, 2017 —

Problem To Solve

Catheter ablation is widely performed using radiofrequency (RF) energy, which is a type of alternating electrical current that can create myocardial lesions. Ablation lesions are formed by direct resistive heating and heat conduction of the tissue involved.

Our Approach

High temperatures at the catheter tip initially limited creation of large lesions, but development of cooled-tip catheters has largely resolved this problem. These catheters deliver higher power to create RF lesions with larger depth and volume as well as decrease char and coagulum formation. However, they have a higher risk of steam pops. These catheters are used in power-controlled mode because temperature feedback at the catheter tip is obscured by substantial saline irrigation. A novel irrigated RF ablation catheter designed with a diamond- embedded tip (for rapid cooling) and six-surface thermocouples (to reflect tissue temperature) is being currently tested at Montefiore and a few other centers.

The catheter has been evaluated for preclinical and clinical performance during pulmonary vein (PV) isolation. The ablation is performed in temperature-controlled mode (60_C/50 W) with the goal of achieving an 80% reduction in high-resolution electrogram (EGM) amplitude.

Luigi Di Biase, MD, PHD, Jorge Romero, MD. Power- Versus Temperature-Guided Radiofrequency Ablation. Have We Found the Perfect Catheter? Journal of American College of Cardiology Aug 2017. Volume. 70, Issue 5, 554-557.

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