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. 2021 Jun;32(6):1594-1599.
doi: 10.1111/jce.15063. Epub 2021 May 12.

RF electrode-tissue coverage significantly influences steam pop incidence and lesion size

Felix Bourier  1 , Miruna Popa  1 , Marc Kottmaier  1 , Susanne Maurer  1 , Fabian Bahlke  1 , Marta Telishevska  1 , Sarah Lengauer  1 , Katharina Koch-Büttner  1 , Marielouise Kornmayer  1 , Elena Risse  1 , Amir Brkic  1 , Tilko Reents  1 , Gabriele Hessling  1 , Isabel Deisenhofer  1
Affiliations

RF electrode-tissue coverage significantly influences steam pop incidence and lesion size

Felix Bourier et al. J Cardiovasc Electrophysiol. 2021 Jun.

Abstract

Background: Steam pops are a rare complication associated with radiofrequency (RF) ablation and are hard to predict. The aim of this study was to assess the influence of coverage between the RF ablation electrode and cardiac tissue on steam pop incidence and lesion size.

Methods and results: An ex vivo model using porcine cardiac preparations and contact force sensing catheters was designed to perform RF ablations at different coverage levels between the RF electrode and cardiac tissue. During coverage level I, only the distal part of the ablation electrode was in contact with tissue. During coverage level II half of the ablation electrode, and during coverage level III the entire ablation electrode was embedded in tissue. RF applications (n = 60) at different coverage levels I-III were systematically performed using the same standardized ablation protocol. Ablations during coverage level III resulted in a significantly higher rate of steam pops (100%) when compared to ablations during coverage level II (10%) and coverage level I (0%), log rank p < .001. Coverage level I ablations resulted in significantly smaller lesion depths, diameters, and impedance drops when compared to higher coverage level ablations, p < .001. In the controlled ex vivo model, there was no difference in applied contact force or energy between different coverage levels.

Conclusions: The level of coverage between RF electrode, cardiac tissue, and the surrounding fluid significantly influenced the incidence of steam pops in an ex vivo setup. Larger coverage between RF electrode and tissue resulted in significantly larger lesion dimensions.

Keywords: lesion size; radiofrequency ablation; steam pop.

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Comment in

  • Tissue coverage matters.
    Kanagasundram A, Richardson TD, Stevenson WG. Kanagasundram A, et al. J Cardiovasc Electrophysiol. 2021 Jun;32(6):1600-1601. doi: 10.1111/jce.15055. Epub 2021 May 12. J Cardiovasc Electrophysiol. 2021. PMID: 33928705 No abstract available.

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