Development of New Device to Improve Sucess Rate of MazeProcedure with Radiofrequency Energy

Nam Hee Park; M.D.*; Yang gi Yoo; M.D.**; Jae Won Lee; M.D.**

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Korean J Thorac Cardiovasc Surg 2004; 37(6): 467-473

Published online June 5, 2004

Development of New Device to Improve Sucess Rate of MazeProcedure with Radiofrequency Energy

Nam Hee Park, M.D.*, Yang gi Yoo, M.D.**, Jae Won Lee, M.D.**

Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Department of Thoracic, and Cardiovascular Surgery, Asan Medical Center, College of Medicine, Ulsan University

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background: The sinus conversion rate after the maze procedure in chronic atrial fibrillation using radiofrequency energy is lower than with either conventional 'cut and saw' technique or cryothermia. The creation of incomplete transmural lesions due to poor tissue-catheter contact is thought to be the main cause. To address this problem, the current study was aimed to evaluate the effectiveness of a specially constructed compression device designed to enhance tissue catheter contact during unipolar radiofrequency catheter ablation. Material and Method: Circumferential right auricular epicardial lesions were created with a linear radiofrequency catheter in 10 anesthetized pigs. A device specially designed to increase contact by compression of the catheter to the atrial wall was used in 5 pigs (study group). This device was not used in the control group (5 pigs). Conduction block across the right auricular lesion was assessed by pacing, and the transmurality of the lesions were confirmed by microscopic examination. Result: Conduction block was observed in a total of 8 pigs; 5 in study group and 3 in control group. Transmural injury was confirmed microscopically by the accumulation of acute inflammatory cells and loss of elastic fibers in the endocardium. In two pigs with failed conduction block, microscopic examination of the endocardium appeared normal. Conclusion: Failed radiofrequency ablation is strongly related to non-transmural energy delivery. The specially constructed compression device in the current study was successful in creating firm tissue-catheter contact and thereby generating transmural lesions during unipolar radiofrequency ablation. (Korean J Thorac Cardiovasc Surg 2004;37:467-473)

Keywords: 1. Radiofrequency 2. Arrhythmia surgery