Radiofrequency current directed across the mitral anulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs

W. M. Jackman, K. H. Kuck, Gerald Naccarelli, L. Carmen, J. Pitha

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

This study tested the capability of low-power radiofrequency current delivered through a bipolar 'epicardial-endocardial' catheter electrode configuration to produce discrete epicardial left atrial (LA) and left ventricular (LV) necrosis adjacent to the mitral anulus for potential application in ablating left free-wall accessory atrioventricular pathways. In 15 anesthetized, closed-chest dogs, a 6F electrode catheter was inserted via the jugular vein into the coronary sinus (CS). A second catheter was inserted via the femoral artery into the left ventricle and positioned beneath the mitral valve, high against the anulus, and directly opposite the CS electrode. The LV tip electrode was positioned to record the largest LA potential to ensure proximity to the anulus. Thirty-four sites were tested (five anterior, 14 lateral, and 15 posterior). Radiofrequency current (continuous wave, 625 kHz) was delivered between the CS and LV electrodes at 37-55 V (median, 41 V) for 4-60 seconds (median, 20 seconds). Current ranged from 0.10 to 0.35 A (median, 0.18 A), resulting in power ranging from 4.3 to 19.2 W (median, 7.3 W) and total energy of 51-446 J (median, 152 J). Dogs were sacrificed 2-9 days later. The CS was grossly intact in all dogs and thrombosed in one dog. The circumflex artery was grossly normal in all dogs. Necrosis of a small segment of the arterial wall was found microscopically in one dog. Lesions were identified at 30 of the 34 sites. Twenty-two (73%) of the 30 lesions consisted of a cylindrical-shaped area of necrosis extending between the anulus and CS with diameter ranging from 2.1 to 15.0 mm (median, 4.0 mm). Atrial and ventricular epicardial necrosis extended 0-7.0 mm (median, 2.5 mm) and 0-6.8 mm (median, 2.6 mm) beyond the anulus, respectively. At the remaining eight (27%) sites little or no epicardial injury occurred, possibly because of downward displacement of LV electrode (four sites) or positioning of LV electrode within a trabecular recess (four sites). We conclude that 1) radiofrequency current delivered between CS and LV produced, at 22 (65%) of 34 sites, LA and LV necrosis adjacent to the anulus without rupture of the CS and that 2) large, sharp LA potentials help identify an optimal anular location of LV electrode. This technique may have clinical usefulness for ablating left free-wall accessory atrioventricular connections.

Original languageEnglish (US)
Pages (from-to)1288-1298
Number of pages11
JournalCirculation
Volume78
Issue number5 I
DOIs
StatePublished - Jan 1 1988

Fingerprint

Coronary Sinus
Electrodes
Catheters
Dogs
Necrosis
Accessory Atrioventricular Bundle
Jugular Veins
Femoral Artery
Mitral Valve
Heart Ventricles
Rupture
Thrombosis
Thorax
Arteries
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{a3be3ccaa54846a7b83619840614e927,
title = "Radiofrequency current directed across the mitral anulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs",
abstract = "This study tested the capability of low-power radiofrequency current delivered through a bipolar 'epicardial-endocardial' catheter electrode configuration to produce discrete epicardial left atrial (LA) and left ventricular (LV) necrosis adjacent to the mitral anulus for potential application in ablating left free-wall accessory atrioventricular pathways. In 15 anesthetized, closed-chest dogs, a 6F electrode catheter was inserted via the jugular vein into the coronary sinus (CS). A second catheter was inserted via the femoral artery into the left ventricle and positioned beneath the mitral valve, high against the anulus, and directly opposite the CS electrode. The LV tip electrode was positioned to record the largest LA potential to ensure proximity to the anulus. Thirty-four sites were tested (five anterior, 14 lateral, and 15 posterior). Radiofrequency current (continuous wave, 625 kHz) was delivered between the CS and LV electrodes at 37-55 V (median, 41 V) for 4-60 seconds (median, 20 seconds). Current ranged from 0.10 to 0.35 A (median, 0.18 A), resulting in power ranging from 4.3 to 19.2 W (median, 7.3 W) and total energy of 51-446 J (median, 152 J). Dogs were sacrificed 2-9 days later. The CS was grossly intact in all dogs and thrombosed in one dog. The circumflex artery was grossly normal in all dogs. Necrosis of a small segment of the arterial wall was found microscopically in one dog. Lesions were identified at 30 of the 34 sites. Twenty-two (73{\%}) of the 30 lesions consisted of a cylindrical-shaped area of necrosis extending between the anulus and CS with diameter ranging from 2.1 to 15.0 mm (median, 4.0 mm). Atrial and ventricular epicardial necrosis extended 0-7.0 mm (median, 2.5 mm) and 0-6.8 mm (median, 2.6 mm) beyond the anulus, respectively. At the remaining eight (27{\%}) sites little or no epicardial injury occurred, possibly because of downward displacement of LV electrode (four sites) or positioning of LV electrode within a trabecular recess (four sites). We conclude that 1) radiofrequency current delivered between CS and LV produced, at 22 (65{\%}) of 34 sites, LA and LV necrosis adjacent to the anulus without rupture of the CS and that 2) large, sharp LA potentials help identify an optimal anular location of LV electrode. This technique may have clinical usefulness for ablating left free-wall accessory atrioventricular connections.",
author = "Jackman, {W. M.} and Kuck, {K. H.} and Gerald Naccarelli and L. Carmen and J. Pitha",
year = "1988",
month = "1",
day = "1",
doi = "10.1161/01.CIR.78.5.1288",
language = "English (US)",
volume = "78",
pages = "1288--1298",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "5 I",

}

Radiofrequency current directed across the mitral anulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs. / Jackman, W. M.; Kuck, K. H.; Naccarelli, Gerald; Carmen, L.; Pitha, J.

In: Circulation, Vol. 78, No. 5 I, 01.01.1988, p. 1288-1298.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiofrequency current directed across the mitral anulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs

AU - Jackman, W. M.

AU - Kuck, K. H.

AU - Naccarelli, Gerald

AU - Carmen, L.

AU - Pitha, J.

PY - 1988/1/1

Y1 - 1988/1/1

N2 - This study tested the capability of low-power radiofrequency current delivered through a bipolar 'epicardial-endocardial' catheter electrode configuration to produce discrete epicardial left atrial (LA) and left ventricular (LV) necrosis adjacent to the mitral anulus for potential application in ablating left free-wall accessory atrioventricular pathways. In 15 anesthetized, closed-chest dogs, a 6F electrode catheter was inserted via the jugular vein into the coronary sinus (CS). A second catheter was inserted via the femoral artery into the left ventricle and positioned beneath the mitral valve, high against the anulus, and directly opposite the CS electrode. The LV tip electrode was positioned to record the largest LA potential to ensure proximity to the anulus. Thirty-four sites were tested (five anterior, 14 lateral, and 15 posterior). Radiofrequency current (continuous wave, 625 kHz) was delivered between the CS and LV electrodes at 37-55 V (median, 41 V) for 4-60 seconds (median, 20 seconds). Current ranged from 0.10 to 0.35 A (median, 0.18 A), resulting in power ranging from 4.3 to 19.2 W (median, 7.3 W) and total energy of 51-446 J (median, 152 J). Dogs were sacrificed 2-9 days later. The CS was grossly intact in all dogs and thrombosed in one dog. The circumflex artery was grossly normal in all dogs. Necrosis of a small segment of the arterial wall was found microscopically in one dog. Lesions were identified at 30 of the 34 sites. Twenty-two (73%) of the 30 lesions consisted of a cylindrical-shaped area of necrosis extending between the anulus and CS with diameter ranging from 2.1 to 15.0 mm (median, 4.0 mm). Atrial and ventricular epicardial necrosis extended 0-7.0 mm (median, 2.5 mm) and 0-6.8 mm (median, 2.6 mm) beyond the anulus, respectively. At the remaining eight (27%) sites little or no epicardial injury occurred, possibly because of downward displacement of LV electrode (four sites) or positioning of LV electrode within a trabecular recess (four sites). We conclude that 1) radiofrequency current delivered between CS and LV produced, at 22 (65%) of 34 sites, LA and LV necrosis adjacent to the anulus without rupture of the CS and that 2) large, sharp LA potentials help identify an optimal anular location of LV electrode. This technique may have clinical usefulness for ablating left free-wall accessory atrioventricular connections.

AB - This study tested the capability of low-power radiofrequency current delivered through a bipolar 'epicardial-endocardial' catheter electrode configuration to produce discrete epicardial left atrial (LA) and left ventricular (LV) necrosis adjacent to the mitral anulus for potential application in ablating left free-wall accessory atrioventricular pathways. In 15 anesthetized, closed-chest dogs, a 6F electrode catheter was inserted via the jugular vein into the coronary sinus (CS). A second catheter was inserted via the femoral artery into the left ventricle and positioned beneath the mitral valve, high against the anulus, and directly opposite the CS electrode. The LV tip electrode was positioned to record the largest LA potential to ensure proximity to the anulus. Thirty-four sites were tested (five anterior, 14 lateral, and 15 posterior). Radiofrequency current (continuous wave, 625 kHz) was delivered between the CS and LV electrodes at 37-55 V (median, 41 V) for 4-60 seconds (median, 20 seconds). Current ranged from 0.10 to 0.35 A (median, 0.18 A), resulting in power ranging from 4.3 to 19.2 W (median, 7.3 W) and total energy of 51-446 J (median, 152 J). Dogs were sacrificed 2-9 days later. The CS was grossly intact in all dogs and thrombosed in one dog. The circumflex artery was grossly normal in all dogs. Necrosis of a small segment of the arterial wall was found microscopically in one dog. Lesions were identified at 30 of the 34 sites. Twenty-two (73%) of the 30 lesions consisted of a cylindrical-shaped area of necrosis extending between the anulus and CS with diameter ranging from 2.1 to 15.0 mm (median, 4.0 mm). Atrial and ventricular epicardial necrosis extended 0-7.0 mm (median, 2.5 mm) and 0-6.8 mm (median, 2.6 mm) beyond the anulus, respectively. At the remaining eight (27%) sites little or no epicardial injury occurred, possibly because of downward displacement of LV electrode (four sites) or positioning of LV electrode within a trabecular recess (four sites). We conclude that 1) radiofrequency current delivered between CS and LV produced, at 22 (65%) of 34 sites, LA and LV necrosis adjacent to the anulus without rupture of the CS and that 2) large, sharp LA potentials help identify an optimal anular location of LV electrode. This technique may have clinical usefulness for ablating left free-wall accessory atrioventricular connections.

UR - http://www.scopus.com/inward/record.url?scp=0023745244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023745244&partnerID=8YFLogxK

U2 - 10.1161/01.CIR.78.5.1288

DO - 10.1161/01.CIR.78.5.1288

M3 - Article

VL - 78

SP - 1288

EP - 1298

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 5 I

ER -