Characterization of the impact of catheter-tissue contact force in lesion formation during cavo-tricuspid isthmus ablation in an experimental swine model.
OBJECTIVE
Catheter-tissue contact is critical for effective lesion creation. The objective of this study was to determine in an experimental swine model the pathological effects of cavo-tricuspid isthmus ablation using two systems that provide reliable measures of the pressure at the catheter tip during radiofrequency ablation procedures.


RESULTS
We performed the procedure in eight pigs in our experimental electrophysiology laboratory after right femoral vein dissection and insertion of a 12 Fr. introducer during general anaesthesia and endotracheal intubation. The target contact force during the applications was <10 grs. (axial or lateral), 10-20, 20-30, and >30 grs. in two pigs each. The power was set at 40 W and maximum target temperature at 45°C. We performed a radiofrequency line dragging from the tricuspid valve to the inferior vena cava in the eight pigs. Euthanasia of the animals was carried out a week after the procedure and a pathological examination of the lesions was performed. In the endocardial macroscopic analysis the extent of lesions, presence of thrombus, transmurality, and endothelial rupture was assessed. External surface was examined searching for transmural lesions. The mean contact force applied was 18.7 ± 8.4 grs. and the mean depth of the lesions was 3.6 ± 2 mm. Lesions were never transmural with average forces <10 grs., and the mean depth was very low (0.75 mm). To achieve transmural lesions contact forces of at least 20 grs. were required. We found a positive correlation (r = 0.85, P < 0.05) between the average force during the applications and depth of the lesions.


CONCLUSIONS
When ablating the cavo-tricuspid isthmus in a swine model, contact forces of at least 20 grs. are required to achieve transmural lesions. Catheter-tissue contact is critical for effective lesion creation. This information is important for improving ablation efficacy.
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain robmatia@gmail.com.
Roberto
R
Matía Francés
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain.
Antonio
A
Hernández Madrid
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain.
Antonia
A
Delgado
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain.
Laura
L
Carrizo
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain.
Carlos
C
Pindado
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain.
Concepción
C
Moro Serrano
Cardiology Department, Ramón y Cajal Hospital, Ctra. Colmenar Km. 9,1, 28034 Madrid, Spain.
José L
JL
Zamorano Gómez
D000818:Animals; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D023421:Models, Animal; D011312:Pressure; D013552:Swine; D013997:Time Factors; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*
Ablation; Isthmus; Radiofrequency