Our aim was to compare the different methods of modeling the effect of circulating blood flow on the thermal lesion dimensions created by radio frequency (RF) cardiac ablation and on the maximum blood temperature. Computational models were built to study the temperature distributions and lesion dimensions created by a nonirrigated electrode by two RF energy delivery protocols (constant voltage and constant temperature) under high and low blood flow conditions. Four methods of modeling the effect of circulating blood flow on lesion dimensions and temperature distribution were compared. Three of them considered convective coefficients at the electrode-blood and tissue-blood interfaces to model blood flow: 1) without including blood as a part of the domain; 2) constant electrical conductivity of blood; and 3) temperature-dependent electrical conductivity of blood (+2%/°C). Method 4) included blood motion and was considered to be a reference method for comparison purposes. Only Method 4 provided a realistic blood temperature distribution. The other three methods predicted lesion depth values similar to those of the reference method (differences smaller than 1 mm), regardless of ablation mode and blood flow conditions. Considering the aspects of lesion size and maximum temperature reached in blood and tissue, Method 2 seems to be the most suitable alternative to Method 4 in order to reduce the computational complexity. Our findings could have an important implication in future studies of RF cardiac ablation, in particular, in choosing the most suitable method to model the thermal effect of circulating blood.

Radiofrequency catheter ablation (RFCA) is a routine treatment for cardiac arrhythmias. During RFCA, the electrode-tissue interface temperature should be kept below 80°C to avoid thrombus formation. Open-irrigated electrodes facilitate power delivery while keeping low temperatures around the catheter. No computational model of an open-irrigated electrode in endocardial RFCA accounting for both the saline irrigation flow and the blood motion in the cardiac chamber has been proposed yet. We present the first computational model including both effects at once. The model has been validated against existing experimental results. Computational results showed that the surface lesion width and blood temperature are affected by both the electrode design and the irrigation flow rate. Smaller surface lesion widths and blood temperatures are obtained with higher irrigation flow rate, while the lesion depth is not affected by changing the irrigation flow rate. Larger lesions are obtained with increasing power and the electrode-tissue contact. Also, larger lesions are obtained when electrode is placed horizontally. Overall, the computational findings are in close agreement with previous experimental results providing an excellent tool for future catheter research.

Although accurate modeling of the thermal performance of irrigated-tip electrodes in radiofrequency cardiac ablation requires the solution of a triple coupled problem involving simultaneous electrical conduction, heat transfer, and fluid dynamics, in certain cases it is difficult to combine the software with the expertise necessary to solve these coupled problems, so that reduced models have to be considered. We here focus on a reduced model which avoids the fluid dynamics problem by setting a constant temperature at the electrode tip. Our aim was to compare the reduced and full models in terms of predicting lesion dimensions and the temperatures reached in tissue and blood. The results showed that the reduced model overestimates the lesion surface width by up to 5 mm (i.e. 70%) for any electrode insertion depth and blood flow rate. Likewise, it drastically overestimates the maximum blood temperature by more than 15 °C in all cases. However, the reduced model is able to predict lesion depth reasonably well (within 0.1 mm of the full model), and also the maximum tissue temperature (difference always less than 3 °C). These results were valid throughout the entire ablation time (60 s) and regardless of blood flow rate and electrode insertion depth (ranging from 0.5 to 1.5 mm). The findings suggest that the reduced model is not able to predict either the lesion surface width or the maximum temperature reached in the blood, and so would not be suitable for the study of issues related to blood temperature, such as the incidence of thrombus formation during ablation. However, it could be used to study issues related to maximum tissue temperature, such as the steam pop phenomenon.

The efficacy of treating atrial fibrillation by RF ablation on the epicardial surface is currently under question due to the presence of epicardial adipose tissue interposed between the ablation electrode and target site (atrial wall). The problem is probably caused by the electrical conductivity of the fat (0.02 S/m) being lower than that of the atrial tissue (0.4-0.6 S/m). Since our objective is to improve epicardial RF ablation techniques, we planned a study based on a two-dimensional mathematical model including an active electrode, a fragment of epicardial fat over a fragment of atrial tissue, and a section of atrium with circulating blood. Different procedures for applying RF power were studied, such as varying the frequency, using a cooled instead of a dry electrode, and different modes of controlling RF power (constant current, temperature and voltage) for different values of epicardial fat thickness. In general, the results showed that the epicardial fat layer seriously impedes the passage of RF current, thus reducing the effectiveness of atrial wall RF ablation.

The aim of this study was to compare the efficacy of bipolar (BM) vs. unipolar (UM) mode of radiofrequency ablation (RFA) in terms of creating transmural lesions across the interventricular septum (IVS) and ventricular free wall (VFW). We built computational models to study the temperature distributions and lesion dimensions created by BM and UM on IVS and VFW during RFA. Two different UM types were considered: sequential (SeUM) and simultaneous (SiUM). The effect of ventricular wall thickness, catheter misalignment, epicardial fat, and presence of air in the epicardial space were also studied. Regarding IVS ablation, BM created transmural and symmetrical lesions for wall thicknesses up to 15 mm. SeUM and SiUM were not able to create transmural lesions with IVS thicknesses ≥12.5 and 15 mm, respectively. Lesions were asymmetrical only with SeUM. For VFW ablation, BM also created transmural lesions for wall thicknesses up to 15 mm. However, with SeUM and SiUM transmurality was obtained for VFW thicknesses ≤7.5 and 12.5 mm, respectively. With the three modes, VFW lesions were always asymmetrical. In the scenario with air or a fat tissue layer on the epicardial side, only SiUM was capable of creating transmural lesions. Overall, BM was superior to UM in IVS and VFW ablation when the catheters were not aligned. Our findings suggest that BM is more effective than UM in achieving transmurality across both ventricular sites, except in the situation of the epicardial catheter tip surrounded by air or placed over a fat tissue layer.

Purpose: The thermal effect of the intramyocardial blood perfusion on the size of lesions created by radiofrequency cardiac ablation (RFCA) has not been adequately studied to date. Our objective was to assess the impact of including this phenomenon in RFCA computer modelling in terms of the thermal lesion depth created. Methods: A computer model was built and computer simulations were conducted to assess the effect of including the blood perfusion term in the bioheat equation. This term mimics the intramyocardial blood flow (i.e., blood perfusion) in the cardiac wall at the site at which the RFCA is being conducted and hence represents a heat removing mechanism. When considered, blood perfusion rates ranged from 609 to 1719 ml/min/kg. Two electrode design and modes were considered: a non-irrigated electrode with constant temperature mode and an irrigated electrode with constant power mode. Results: All the depths computed without including the blood perfusion term were larger than those that did include it, regardless of perfusion rate. The differences in lesion depth between ignoring and including blood perfusion increased over time; for a 60 s RFCA they were 0.45 and 1 mm for minimum and maximum perfusion rate, respectively. The differences were more or less independent of blood flow in the cardiac chamber, electrode type and ablation mode. Conclusions: The findings suggest that the heat-sink effect of blood perfusion should be taken into account in the case of ablations (>1 minute) such as those conducted in RFCA of the ventricular wall.