Theoretical and experimental analysis of amplitude control ablation and bipolar ablation in creating linear lesion and discrete lesions for treating atrial fibrillation.

PURPOSE: Radiofrequency (RF) energy is often used to create a linear lesion or discrete lesions for blocking the accessory conduction pathways for treating atrial fibrillation. By using finite element analysis, we study the ablation effect of amplitude control ablation mode (AcM) and bipolar ablation mode (BiM) in creating a linear lesion and discrete lesions in a 5-mm-thick atrial wall; particularly, the characteristic of lesion shape has been investigated in amplitude control ablation.

MATERIALS AND METHODS: Computer models of multipolar catheter were developed to study the lesion dimensions in atrial walls created through AcM, BiM and special electrodes activated ablation methods in AcM and BiM. To validate the theoretical results in this study, an in vitro experiment with porcine cardiac tissue was performed.

RESULTS: At 40 V/20 V root mean squared (RMS) of the RF voltage for AcM, the continuous and transmural lesion was created by AcM-15s, AcM-5s and AcM-ad-20V ablation in 5-mm-thick atrial wall. At 20 V RMS for BiM, the continuous but not transmural lesion was created. AcM ablation yielded asymmetrical and discrete lesions shape, whereas the lesion shape turned to more symmetrical and continuous as the electrodes alternative activated period decreased from 15 s to 5 s. Two discrete lesions were created when using AcM, AcM-ad-40V, BiM-ad-20V and BiM-ad-40V. The experimental and computational thermal lesion shapes created in cardiac tissue were in agreement.

CONCLUSIONS: Amplitude control ablation technology and bipolar ablation technology are feasible methods to create continuous lesion or discrete for pulmonary veins isolation.