Soft Thrombus Formation in Radiofrequency Catheter Ablation

DEMOLIN, J.M., et al.: Soft Thrombus Formation in Radiofrequency Catheter Ablation. During RF catheter ablation, local temperature elevation can result in coagulum formation on the ablation electrode, resulting in impedance rise. A recent study has also demonstrated the formation of a so‐called soft thrombus during experimental ablations. This deposit poorly adhered to the catheter tip and did not cause an impedance rise. The mechanism of soft thrombus formation and the role of the natural coagulation system are unknown. The formation of a soft thrombus was investigated experimentally by temperature‐controlled RF delivery in heparinized blood at different heparin concentrations and in serum. After 60 seconds of RF delivery in blood with an electrode target temperature of 80°C, a semisolidified mass had formed around the ablation electrode at all heparin concentrations. A smaller but structurally similar deposit had formed after RF delivery in serum. Scanning electron microscopy analysis revealed that these deposits consist of denaturized and aggregated proteins, and not of a classical thrombus. The formation of the so‐called soft thrombus results from heat induced protein denaturation and aggregation and occurs independent of heparin concentration and also in serum. The formation of such deposits may occur at temperatures well below 100°C, which may have important consequences for further development of ablation technologies.