Electrophysiological effects of long, linear atrial lesions placed under intracardiac ultrasound guidance.
Electrophysiological effects of long, linear atrial lesions placed under intracardiac ultrasound guidance.
复制标题
心内超声引导下长线性心房病变的电生理效应。
作者：
J. Olgin;J. Kalman;M. Chin;C. Stillson;Mark A. Maguire;Philip Ursel;M. Lesh
背景
根治性的房颤手术很可能依赖于创建跨壁线性消融损伤。然而，目前尚不清楚心内膜射频损伤是否会产生传导阻滞线。
方法和结果
在6头猪的心内超声心动图引导下，在三个右房位置：(1)从终脊到三尖瓣环，(2)从卵圆窝到终脊，(3)从下腔静脉到三尖瓣环，放置多个线圈阵列导管以桥接右房内膜结构。一旦导管被定位，通过依次对四个线圈的每个线圈施加射频能量来形成线性损伤。15天后，打开胸腔，将112个电极的心外膜斑块放置在心房游离壁病变上，以确定激活模式。每只动物放置3个病灶，平均手术时间为47+/-11分钟。一旦心内超声心动图确定了足够的接触，只需一系列射频应用就可以实现21+/-10W的组织加热(65+/-4℃)。心外膜标测显示所有动物的病变部位都完全传导阻断，病变部位有分裂电位和不同的激活时间(+/-16ms)。在尸检中，所有的损伤都是离散的，连续的，没有烧焦的证据。病变距离目标解剖位置0.3+/-0.5 mm，长21+/-4 mm，宽2.8+/-0.6 mm。组织学检查显示，每个病变的整个长度都有跨壁纤维化。
结论
在正常猪的右心房可以放置电生理上跨壁的、连续的线状病变。使用心内超声心动图，可以确保在几个线圈电极上进行充分的组织接触，从而缩短手术时间，有效地应用能量，并准确定位与解剖相关的病变。
BACKGROUND
A curative atrial fibrillation procedure will most likely rely on creating transmural linear ablative lesions. However, it is currently unknown whether endocardial radiofrequency lesions can create lines of conduction block.
METHODS AND RESULTS
In six pigs, intracardiac echocardiography was used to guide the positioning of multiple coil array catheters to bridge endocardial structures in three right atrial locations: (1) from the crista terminalis to the tricuspid annulus; (2) from the fossa ovalis to the crista terminalis; and (3) from the inferior vena cava to the tricuspid annulus. Once the catheter was positioned, linear lesions were made by radiofrequency energy applied sequentially to each of the four coils. After 15 days, the chest was opened and a 112-electrode epicardial plaque was positioned over the atrial free wall lesion to determine activation patterns. Three lesions were placed in each animal, with a mean procedure time of 47+/-11 minutes. Once adequate contact was determined by intracardiac echocardiography, a single series of radiofrequency application was required to achieve tissue heating (65+/-4 degrees C) with a power of 21+/-10 W. Epicardial mapping demonstrated complete conduction block across the lesions in all animals, with split potentials and disparate activation times (64+/-16 ms) across the lesion. At autopsy, all lesions were discrete, continuous, and without evidence of charring. The lesions were within 0.3+/-0.5 mm of their targeted anatomic locations and measured 21+/-4 mm long and 2.8+/-0.6 mm wide. Histology revealed transmural fibrosis throughout the length of each lesion.
CONCLUSIONS
Linear lesions that are electrophysiologically transmural and continuous can be placed in the right atrium of normal pigs. With intracardiac echocardiography, adequate tissue contact over several coil electrodes can be ensured, resulting in short procedure times, efficient energy application, and accurate anatomically linked lesion placement.
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DOI：
10.1016/s0022-5223(19)36684-x
发表时间：
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影响因子：
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作者：
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影响因子：
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DOI：
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发表时间：
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期刊：
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影响因子：
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