Gold-tip electrodes--a new "deep lesion" technology for catheter ablation? In vitro comparison of a gold alloy versus platinum-iridium tip electrode ablation catheter.
Gold-tip electrodes. Radiofrequency (RF) catheter ablation is widely used to induce focal myocardial necrosis using the effect of resistive heating through high-frequency current delivery. It is current standard to limit the target tissue-electrode interface temperature to a maximum of 60-70 degrees C to avoid char formation. Gold (Au) exhibits a thermal conductivity of nearly four times greater than platinum (Pt-Ir) (3.17 W/cm Kelvin vs 0.716 W/cm Kelvin), it was therefore hypothesized that RF ablation using a gold electrode would create broader and deeper lesions as a result of a better heat conduction from the tissue-electrode interface and additional cooling of the gold electrode by "heat loss" to the intracardiac blood. Both mechanisms would allow applying more RF power to the tissue before the electrode-tissue interface temperature limit is reached. To test this hypothesis, we performed in vitro isolated liver and pig heart investigations comparing lesion depths of a new Au-alloy-tip electrode to standard Pt-Ir electrode material. Mean lesion depth in liver tissue for Pt-Ir was 4.33+/-0.45 mm (n=60) whereas Au electrode was able to achieve significantly deeper lesions (5.86+/-0.37 mm [n=60; P<0.001]). The mean power delivered using Pt-Ir was 6.95+/-2.41 W whereas Au tip electrode delivered 9.64+/-3.78 W indicating a statistically significant difference (P<0.05). In vitro pig heart tissue Au ablation (n=20) increased significantly the lesion depth (Au: 4.85+/-1.01 mm, Pt-Ir: 2.96+/-0.81 mm, n=20; P<0.001). Au tip electrode again applied significantly more power (P<0.001). Gold-tip electrode catheters were able to induce deeper lesions using RF ablation in vitro as compared to Pt-Ir tip electrode material. In liver and in pig heart tissue, the increase in lesion depth was associated with a significant increase in the average power applied with the gold electrode at the same level of electrode-tissue temperature as compared to platinum material.
Lewalter
Thorsten
T
Department of Medicine-Cardiology, University of Bonn, Bonn, Germany. th.lewalter@uni-bonn.de
Bitzen
Alexander
A
Wurtz
Sabine
S
Blum
Robert
R
Schlodder
Karsten
K
Yang
Alexander
A
Lickfett
Lars
L
Schwab
Jörg O
JO
Schrickel
Jan W
JW
Tiemann
Klaus
K
Linhart
Markus
M
Zima
Endre
E
Merkely
Bela
B
Lüderitz
Berndt
B
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D017115:Catheter Ablation / Q000295:instrumentation*; D004566:Electrodes / Q000592:standards; D004867:Equipment Design; D006046:Gold; D066298:In Vitro Techniques; D007495:Iridium; D008099:Liver / Q000601:surgery*; D010984:Platinum; D013552:Swine
D007495:Iridium; D010984:Platinum; D006046:Gold