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Ablative techniques, using standard defibrillators and commonly available cardiac catheters, have been applied to the His bundle and bypass tracts for the management of arrhythmias. We have done in vitro studies of the physical effects of these high energy electrical impulses delivered via different pacing electrodes. Unipolar impulses of 10 to 400 joules were delivered via three U.S.C.I. bipolar electrodes and three Vitatron Helifix electrodes immersed in Ringer's solution. The effects were recorded on 35 mm still film, video tape, and high speed cine film. Pressure, voltage, and current were measured. The U.S.C.I. bipolar electrodes and the Vitatron Helifix electrodes safely withstood repeated delivery of 400-joule impulses which produced similar flash shapes. Each took the form of an incandescent, spherical "fire-ball" centered around the exposed electrode surface. The mean diameters of the "fire-ball" for 10 to 400 J using the U.S.C.I. electrodes were 5-24 mm and 3-20 mm for the Helifix catheter electrodes. Peak pressure excursions of over an atmosphere were observed 3 cm from the electrode tips. Higher pressures, lower voltages, and larger currents occurred using the U.S.C.I. pacing lead. The simple, 35 mm time exposure technique showed that at low energies the flashes appeared to emerge in a retrograde manner from the U.S.C.I. catheters and more distally from the Helifix electrode. This suggested that the latter might be more effective with lower energy impulses. It is concluded that lower energies should be used to take full advantage of the active fixation electrode.
Boyd et al. (Fri,) studied this question.