نبذة مختصرة : Objectives: This study sought to examine the effect of the return electrode's surface area on bipolar RFA lesion size.
Background: Bipolar radiofrequency ablation (RFA) is typically performed between 2 3.5-mm tip catheters serving as active and return electrodes. We hypothesized that increasing the surface area of the return electrode would increase lesion dimensions by reducing the circuit impedance, thus increasing the current into a larger tissue volume enclosed between the electrodes.
Methods: In step 1, ex vivo bipolar RFA was performed between 3.5-mm and custom-made return electrodes with increasing surface areas (20, 80, 180 mm 2 ). In step 2, ex vivo bipolar RFA was performed between 3.5-mm and 3.5-mm or 8-mm electrode catheters positioned perpendicular or parallel to the tissue. In step 3, in vivo bipolar RFA was performed between 3.5-mm and either 3.5-mm or 8-mm parallel electrode at the: 1) left ventricular summit; 2) interventricular septum; and 3) healed anterior infarction.
Results: In step 1, increasing the surface area of the return electrode resulted in lower circuit impedance (R = -0.65; P < 0.001), higher current (R = +0.80; P < 0.001), and larger lesion volume (R = +0.88; P < 0.001). In step 2, an 8-mm return electrode parallel to tissue produced larger and deeper lesions compared with a 3.5-mm return electrode (P = 0.014 and P = 0.02). Similarly, in step 3, compared with a 3.5-mm, bipolar RFA with an 8-mm return electrode produced larger (volume: 1,525 ± 871 mm 3 vs 306 ± 310 mm 3 , respectively; P < 0.001) and more transmural lesions (88% vs 0%; P < 0.001).
Conclusions: Bipolar RFA using an 8-mm return electrode positioned parallel to the tissue produces larger lesions in comparison with a 3.5-mm return electrode.
Competing Interests: Funding Support and Author Disclosures Mr Bubar is an employee of Biosense Webster. Dr Tarakji receives consultation fees from AliveCor, Medtronic, Janssen, and Pfizer. Dr Anter has received research grants and speaking honoraria from Biosense Webster, Boston Scientific, Affera Inc, and Itamar Medical; and holds stock options in Affera Inc. Dr Koruth has received research grants from Affera Inc, Farapulse, Cardiofocus, Biosense, Acutus, Kardium; has equity in Affera Inc; and serves as a consultant to Farapulse and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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