The advent of irrigated radiofrequency (RF) catheters has led to the common misconception
that irrigation somehow makes ablation both safer and more effective. In fact, this
is not true. Irrigation (or any other means of cooling the catheter tip) results in
the ability to deliver greater energy and as such can lead to steam pops, collateral
damage, and thrombus formation. It is important to recognize that irrigation allows greater energy delivery; it does not mandate it. The operator must determine the appropriate power settings, irrigant
flow rates, and lesion duration for each ablation site. This requires balancing the
competing demands of efficacy (transmural tissue destruction) against those of safety
(avoidance of catheter or tissue overheating and/or collateral tissue heating). Current
technological limitations require that these decisions be based on incomplete information
about the tissue effects of ablation. We will review the biophysics of RF ablation
and the role of irrigation to provide a context for making rational decisions about
the use of irrigated RF catheters.
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References
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Article info
Publication history
Published online: January 15, 2008
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Copyright
© 2008 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
