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European Heart Journal 1998 19(7):1075-1084; doi:10.1053/euhj.1998.1015
Copyright © 1998 by the European Society of Cardiology.
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Bipolar radiofrequency catheter ablation creates confluent lesions at a larger interelectrode spacing than does unipolar ablation from two electrodes in the porcine heart

AnfinsenO.-G af2, E Kongsgaarda, A Foersterbf1, J.P Amliea and H Aassa

a Medical Department B and Institute for Surgical Research, Rikshospitalet, Oslo, Norway
b Department of Pathology, Rikshospitalet, Oslo, Norway

accepted January 25, 1998

Aims

Radiofrequency catheter ablation of atrial flutter and fibrillation may be favoured by large, elongated lesions. We compared bipolar ablation with unipolar ablation from one or two electrodes in the porcine heart.

Methods and Results

In vitro, confluent lesions were reliably created by a ‘dielectrode’ catheter (energy delivered simultaneously (in parallel) from two 4mm electrodes spaced 1mm apart, towards an indifferent electrode), and a ‘bipolar’ catheter (energy delivered (in series) between two 4mm electrodes spaced 5mm apart). Sixteen anaesthetized pigs were randomized to standard unipolar (4), dielectrode (6) or bipolar (6) ablation. Two radiofrequency current deliveries of 30s duration (70°C) were administered to the inferior vena cava–tricuspid valve isthmus and two to the right atrial free wall in all animals. After 4h, the lesions were examined macroscopically and histologically. Mean (SD) endocardial lesion lengthxwidthxdepth measured 7·4 (2·4)x5·4 (2·2)x2·8 (0·8)mm in the standard unipolar mode, 10·2 (1·4)x6·3 (0·7)x3·3 (1·1)mm in the dielectrode mode and 14·0 (3·6)x6·0 (1·7)x3·8 (1·2)mm in the bipolar mode. Thus lesion length increased significantly through the three groups (P<0·001), while width and depth did not.

Conclusion

Both dielectrode and bipolar ablation were feasible in porcine right atrial ablation, and created longer lesions than the standard unipolar mode. By allowing a larger interelectrode distance, bipolar ablation created the longest lesions and may be favourable when linear lesions are necessary.

Key Words: Catheter ablation • bipolar • unipolar • inter-electrode distance • porcine heart

f2 Correspondence: Ole-Gunnar Anfinsen, Medical Department B, Rikshospitalet, N-0027 Oslo, Norway.

f1 Professor Foerster died suddenly 2 months after this paper was accepted.


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