RF electrode-tissue coverage significantly influences steam pop incidence and lesion size
RF electrode-tissue coverage significantly influences steam pop incidence and lesion size
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DOI：
10.1111/jce.15063
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发表时间：
2021-05-12
影响因子：
2.7
通讯作者：
Deisenhofer, Isabel
中科院分区：
文献类型：
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作者：
Bourier, Felix;Popa, Miruna;Deisenhofer, Isabel
背景：蒸汽爆裂是射频（RF）消融术的一种罕见并发症，难以预测。本研究的目的是评估蒸汽爆裂的发病率和病变size.Methods和结果之间的RF消融电极和心脏组织的覆盖范围的影响一个离体模型，使用猪心脏准备和接触力传感导管被设计为执行RF消融在不同的覆盖水平之间的RF电极和心脏组织。在I级覆盖期间，只有消融电极的远端部分与组织接触。在覆盖水平II期间，消融电极的一半，在覆盖水平III期间，整个消融电极嵌入组织中。使用相同的标准化消融方案，系统性地在不同覆盖水平I-III进行射频消融（n = 60）。与覆盖水平II（10%）和覆盖水平I（0%）期间的消融相比，覆盖水平III期间的消融导致蒸汽爆裂率（100%）显著更高，对数秩p <0.001。与较高覆盖水平消融相比，覆盖水平I消融导致显著较小的病变深度、直径和阻抗下降，p <0.001。在控制的离体模型中，施加的接触力或能量之间没有差异不同的coverage levels.Conclusions之间的射频电极，心脏组织，和周围的液体的覆盖水平显着影响蒸汽爆裂的发生率在离体设置。射频电极和组织之间的覆盖范围更大，导致损伤尺寸明显更大。
Background Steam pops are a rare complication associated with radiofrequency (RF) ablation and are hard to predict. The aim of this study was to assess the influence of coverage between the RF ablation electrode and cardiac tissue on steam pop incidence and lesion size.Methods and results An ex vivo model using porcine cardiac preparations and contact force sensing catheters was designed to perform RF ablations at different coverage levels between the RF electrode and cardiac tissue. During coverage level I, only the distal part of the ablation electrode was in contact with tissue. During coverage level II half of the ablation electrode, and during coverage level III the entire ablation electrode was embedded in tissue. RF applications (n = 60) at different coverage levels I-III were systematically performed using the same standardized ablation protocol. Ablations during coverage level III resulted in a significantly higher rate of steam pops (100%) when compared to ablations during coverage level II (10%) and coverage level I (0%), log rank p < .001. Coverage level I ablations resulted in significantly smaller lesion depths, diameters, and impedance drops when compared to higher coverage level ablations, p < .001. In the controlled ex vivo model, there was no difference in applied contact force or energy between different coverage levels.Conclusions The level of coverage between RF electrode, cardiac tissue, and the surrounding fluid significantly influenced the incidence of steam pops in an ex vivo setup. Larger coverage between RF electrode and tissue resulted in significantly larger lesion dimensions.