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Ablation using irrigated radiofrequency: A hands-on guide

Published:January 15, 2008DOI:https://doi.org/10.1016/j.hrthm.2008.01.003
      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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