title: Effects of intracavitary blood flow and electrode-target distance on radiofrequency power required for transient conduction block in a Langendorff-perfused canine model.
abstract: OBJECTIVE
  We sought to quantify the effects of electrode-target distance and intracavitary blood flow on radiofrequency (RF) power required to induce transient conduction block, using a Langendorff-perfused canine ablation model.
  
  
  BACKGROUND
  Given the thermally mediated nature of RF catheter ablation, cooling effects of intracavitary blood flow and electrode-target distance will influence lesion extension and geometry and electrophysiologic effects.
  
  
  METHODS
  In eight Langendorff-perfused canine hearts, the right ventricular free wall was opened, and the right bundle branch (RBB) carefully localized by multielectrode activation mapping. The right atrium was paced at cycle length of 500 ms. Proximal and distal electrodes were attached at the endocardial aspect of the RBB, and the perfused heart was submerged in heparinized blood at 37 degrees C. A standard 4-mm tip ablation electrode was positioned at a constant contact pressure of 5 g between the two electrodes at the site of maximal RBB potential (0 mm) and 2 and 4 mm distant from this site along a line perpendicular to the RBB. RF pulses (500 kHz) were delivered for 30 s at 0.5-W increments until transient bundle branch block. In four hearts, intracavitary flow was simulated by directing a 30-cm/s jet of blood parallel to the septum at the ablation site, and the protocol was repeated to assess the effects on power required for block. In one heart, the effect of variable flow was assessed (0, 15 and 30 cm/s).
  
  
  RESULTS
  An exponential distance-related increase was seen in power required for block, from 1.8 +/- 0.9 W (mean +/- SD) at 0 mm to 5.4 +/- 1.1 W at 4 mm. In the presence of 30-cm/s flow, an increase to 3.9 +/- 0.8 W at 0 mm and 13.1 +/- 2.4 W at 2 mm was seen. At 4 mm, coagulum formation invariably occurred before block could be induced. For 15-cm/s flow, less power was required: 3 and 7 W at 0 and 2 mm, respectively.
  
  
  CONCLUSIONS
  Increasing the ablation electrode-target distance causes an exponential increase in power required for conduction block; this relation is profoundly influenced by intracavitary flow. Given the geometry of endomyocardial RF lesions, these findings are particularly relevant for directly subendocardial ablation targets.
authors.affiliation: Department of Cardiology, Heart-Lung Institute, University Hospital Utrecht, The Netherlands.
authors.forename: T A
authors.initials: TA
authors.lastname: Simmers
authors.forename: J M
authors.initials: JM
authors.lastname: de Bakker
authors.forename: R
authors.initials: R
authors.lastname: Coronel
authors.forename: F H
authors.initials: FH
authors.lastname: Wittkampf
authors.forename: F J
authors.initials: FJ
authors.lastname: van Capelle
authors.forename: M J
authors.initials: MJ
authors.lastname: Janse
authors.forename: R N
authors.initials: RN
authors.lastname: Hauer
mesh_terms: D000818:Animals; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000502:physiology; D004285:Dogs; D017097:Electric Impedance; D004566:Electrodes; D004594:Electrophysiology; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D013696:Temperature