Effects of intracardiac radiofrequency current application on coronary artery vessels in young pigs.
BACKGROUND
Radiofrequency current is widely used in children to ablate accessory AV pathways. Previous data in a pig model demonstrated coronary artery obstruction adjacent to radiofrequency current lesions 48 hours and 6 months after energy delivery. In the present study, the long-term effects (>6 months) of radiofrequency current application on coronary artery vessels in young pigs are assessed.


RESULTS
Radiofrequency current (500 kHz) was delivered over 30 seconds in ten piglets (mean body weight 12.8 kg) using a steerable 6-French catheter with a 4-mm thermistor tip electrode (target temperature 75 degrees C). Lesions were created under fluoroscopic and electrocardiographic guidance at the lateral right atrial (RA) wall above the tricuspid valve orifice, and at the lateral left atrial and left ventricular wall adjacent to the mitral valve orifice. Selective coronary angiography and intravascular ultrasound (IVUS) studies were performed 3, 6, 9, and 12 months after energy application. After 12 months, the lesions were studied pathohistologically. All lesions consisted of compact fibrous tissue. RA lesions extended to the adjacent right coronary artery and led to coronary artery involvement with increased fibrous tissue in the adventitia and media and intimal thickening in three animals. Coronary arterial narrowing was documented by IVUS during follow-up in all three cases 9 months after energy application. Angiography failed to demonstrate coronary pathology in any of the three animals.


CONCLUSIONS
The risk of late coronary artery lesions must be considered when catheter ablation at the RA wall is planned in children with free-wall accessory AV pathways.
Bökenkamp
R
R
Department of Pediatric Cardiology, Hannover Medical School, Germany. Bokenkamp@compuserve.com
Wibbelt
G
G
Sturm
M
M
Windhagen-Mahnert
B
B
Bertram
H
H
Hausdorf
G
G
Paul
T
T
D000818:Animals; D001283:Atrioventricular Node / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D004562:Electrocardiography; D006325:Heart Atria / Q000473:pathology; D006339:Heart Rate; D006352:Heart Ventricles / Q000473:pathology; D013552:Swine; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D018084:Ultrasonography, Interventional