Catheter ablation of canine ventricular myocardium. The use of repetitive short time constant capacitive shocks to increase lesion volume.

Arching and barotrauma, seen with high energy DC catheter ablation, are responsible for diffuse cardiac damage and coronary sinus rupture. In six anesthetized dogs, we investigated the effects of an increasing number of short time-constant capacitive shocks on the volume of myocardial damage. Each dog received capacitive shocks of 2 J/kg at 3 sites in the left ventricle. One shock was delivered in 2 dogs, 2 shocks were delivered in 2 dogs and 3 shocks were delivered in 2 dogs. Shock delivery was not accompanied by hemodynamic collapse, sustained ventricular tachycardia or ventricular fibrillation. The dogs were sacrificed at 60 minutes. Mean (SEM) lesion volumes were 195 (39) mm3, 480 (41) mm3, and 595 (110) mm3, respectively. Despite variability in individual volume of damage, there was a significant increase in lesion volume with an increasing number of shocks. There was no evidence of perforation or tamponade. Increasing myocardial damage can be produced using repetitive capacitive shocks. Delivery of 2 shocks produces clinically useful lesions without the adverse effects associated with single high energy shocks. Repetitive capacitive shocks offer a method of increasing lesion volume without increasing energy and thereby without compromising safety.