Detection of microbubble formation during radiofrequency ablation using phonocardiography

Abstract

Aims: To detect and characterize the acoustic energy generated by microbubble (MB) formation in an isolated tissue preparation. MB formation during radiofrequency (RF) ablation indicates excessive tissue heating and may precede explosive 'pops'. Currently, MB formation can only be detected with echocardiography. We hypothesized that MB formation can be detected with high-sensitivity phonocardiography. Methods and results: In a saline bath, RF lesions were created in sections of porcine left ventricle, using a 4mm tip irrigated catheter. MB formation was visualized with an echocardiography probe. In 20 preparations, RF energy was begun at 25 W and increased by 5 W every 20 s until a pop occurred. A high-sensitivity computerized phonocardiography transducer with frequency bandwidth of 2 kHz and system noise -90 dB (SonoMedica, Inc., Vienna, VA, USA) was coupled to the external glass wall of the bath. In 15 of 20 (75%) preparations, a characteristic acoustic signature corresponding to MB formation was noted before the pop. These signals were within the 600-2000 Hz range and had an intensity range of 10-40 dB. The earliest MB and acoustic signals occurred 51.3 ± 51.5 s before the pop. The acoustic signals continued intermittently up to 10.3 ± 12.9 s before the pop. Conclusion: The acoustic energy created by MB formation can be detected in an isolated tissue preparation, using a computer-based phonocardiography system. Characteristic acoustic signatures are present before pops and correspond to MB formation. Acoustic monitoring for MB formation may allow for the titration of cooled RF ablation without echocardiography. © 2006 Oxford University Press.