Radiofrequency ablation: simultaneous application of multiple electrodes via switching creates larger, more confluent ablations than sequential application in a large animal model.

摘要

PURPOSE: To compare radiofrequency (RF) ablations created by using a sequential technique to those created simultaneously by using a switching algorithm in ex vivo and in vivo liver models. MATERIALS AND METHODS: RF ablation was performed by using either sequential or switched application of three cooled electrodes in a 2-cm triangular array in ex vivo bovine liver (28 total ablations) and in vivo swine liver (12 total ablations) models. For sequential ablations, electrodes were powered for 12 minutes each with a 5-minute rest interval between activations to simulate electrode repositioning. Switched ablations were created by using a multiple-electrode switching system for 12 minutes. Temperatures were measured during ex vivo experiments at four points in the ablation zone. Ablation zones were measured for minimum and maximum diameter, cross-sectional area, and isoperimetric ratio. Mann-Whitney and Wilcoxon matched pairs tests were used to identify differences between groups. RESULTS: The switched application created larger and more circular zones of ablation than did the sequential application, with mean (+/-standard deviation) ex vivo cross-sectional areas of 25.4 cm(2) +/- 5 .3 and 18.8 cm(2) +/- 6.6 (P = .001), respectively, and mean in vivo areas of 17.1 cm(2) +/- 5.1 and 13.2 cm(2) +/- 4.2 (P < .05). Higher temperatures and more rapid heating occurred with the switched application; switched treatments were 74% faster than sequential treatments (12 vs 46 minutes). In the sequential group, subsequent ablations grew progressively larger due to local ischemia. CONCLUSIONS: Switched application of three electrodes creates larger, more confluent ablations in less time than sequential application. Thermal synergy and ablation-induced ischemia both substantially influence multiple-electrode ablations.