title: Linear lesion radiofrequency ablation in canine vagal atrial fibrillation: effects of special catheters designed for efficiency, and the critical role of lesions from the crista terminalis to the superior vena cava.
abstract: OBJECTIVE
  To determine whether specially devised catheters could be used to place radiofrequency (RF) linear lesions quickly and efficiently for termination and/or prevention of atrial fibrillation (AF).
  
  
  METHODS
  Two versions of 2 different types of ablating catheters were used in 12 canines with AF induced by rapid pacing during vagal stimulation. 1) Modified basket catheters in two versions, one designed to produce caudo-cranial linear lesions through extended bare electrode-splines in contact with the atrial wall; and the other designed to produce horizontal linear lesions by revolving within the atrium. Together these would form "longitude and latitude" grids in the atrium. 2) The second catheter type was 2 versions of coil electrodes with thermocouples centered under each of the large-area coil electrodes. One version of these deflectable coil electrodes was intended to produce lesions in the tricuspid valve annulus-inferior vena cava (IVC) isthmus; and along the crista terminalis from the superior vena cava (SVC) to the IVC. A different type of deflection angulation on the second version was intended to produce more horizontal lesions from the crista to the tricuspid annulus. Guidance was fluoroscopic, and by electrograms and transesophageal echo. Gross pathologic examinations followed each experiment. Prior to use in canines, all electrode configurations were tested in vitro on fresh bovine preparations suspended in saline at 37 degrees C.
  
  
  RESULTS
  The bare spline and coil electrode catheter configurations produced discrete non-perforating non-charring lesions in the in vitro preparations. One dog died of exsanginating hemorrhage. Post mortem examination revealed the lesions to be extremely variable, ranging from no evidence of effective RF delivery to deep lesions with perforation. Seven clinical successes were achieved (6 complete), with the coil electrode catheters accounting for 5 of the 7, although the procedure times were shorter with the baskets. Critical lesions were those from the crista to the SVC. Planned trans-isthmus lesions were not done, but may be needed to prevent atrial flutter not seen prior to effective AF ablation.
  
  
  CONCLUSIONS
  Special basket and coil-electrode catheters may be useful but require refinement. The finding that lesions between the crista terminalis and the SVC were critical to success may be applicable to some cases of AF in humans.
authors.affiliation: Cardiovascular Division, Arrhythmia Service and Echocardiology Laboratories, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. jfisher@montefiore.org
authors.forename: J D
authors.initials: JD
authors.lastname: Fisher
authors.forename: S
authors.initials: S
authors.lastname: Kahn
authors.forename: J
authors.initials: J
authors.lastname: Han
authors.forename: A
authors.initials: A
authors.lastname: Kogan
authors.forename: M
authors.initials: M
authors.lastname: Nanna
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D002404:Catheterization; D004195:Disease Models, Animal; D004285:Dogs; D004566:Electrodes; D004594:Electrophysiology; D004867:Equipment Design; D005260:Female; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology; D014683:Vena Cava, Superior / Q000502:physiology