Contrasting effects of convective flow on catheter ablation lesion size: Cryo versus radiofrequency energy

Background: Cryoablation has now become an alternative to treat many cardiac arrhythmias, and may be the treatment of choice in some patient populations. We compared the effects of convective flow on large-tip cryo and radiofrequency (RF) lesions dimensions. Methods: Cryoablation and RF ablation were performed on porcine heart sections in a saline bath with varying directed flow rates. Cryoablation was performed for 4 minutes on 50 tissue pieces with tip temperature controlled at -80 degrees C. RF ablation was performed on 50 tissue pieces for 60 seconds at 60 degrees C tip temperature. The pieces were placed in culture media for 24 hours, and then sectioned, stained, and measured. Results: Cryoablation and RF lesion sizes varied significantly with flow such that higher flow rates produced smaller cryoablation lesions and larger RF lesions (mean cryoablation volumes: 854 +/- 402, 808 +/- 217, 781 +/- 217, 359 +/- 114, and 292 +/- 117 mm(3), and mean RF volumes: 211 +/- 35, 304 +/- 79, 439 +/- 125, 525 +/- 187, and 597 +/- 126 mm(3) for 0, 1, 2, 3, and 5L/min flow rates, respectively, P < 0.0005). Trabeculated pieces had larger cryoablation lesions and smaller RF lesions than nontrabeculated ones at higher flow rate (P < 0.005). Cryoablation lesion volume increased as the time to reach -80 degrees C decreased (r(2) = 0.72). Conclusion: In contrast to RF ablation, cryoablation lesion size is smaller at high flow rates, and larger at low flow rates due to the warming effects of local convective flow. The effects of high flow are reduced in areas of trabeculation, and the time to reach -80 degrees C predicts cryoablation lesion size.