Characterization of Radiofrequency Ablation Lesion Development Based on Simulated and Measured Intracardiac Electrograms
Characterization of Radiofrequency Ablation Lesion Development Based on Simulated and Measured Intracardiac Electrograms
复制标题
DOI：
10.1109/tbme.2014.2322515
复制
发表时间：
2014-09-01
影响因子：
4.6
通讯作者：
Luik, Armin
中科院分区：
文献类型：
--
作者：
Keller, Matthias Walter;Schuler, Steffen;Luik, Armin
射频消融（RFA）疗法是许多心律失常介入治疗的金标准。一个主要障碍是非透壁病变，导致心律失常复发。最近的临床研究表明心内电图（EGM）标准作为评估病变发展的有前途的标志物。为了更深入地了解潜在机制，我们建立了一种急性 RFA 病变的模拟方法。消融损伤由被动坏死核心建模，该核心被具有加热心肌特性的边界区包围。在此，传导速度和电生理特性发生了改变。我们在 RFA 期间模拟 EGM，以使用双域模型研究病变形成和 EGM 变化之间的关系。在三维设置上进行模拟，包括具有高导电电极的导管的几何详细表示。为了进行验证，我们对 5 名患者在 RFA 手术期间记录的 EGM 进行了分析，并与模拟结果进行了比较。临床数据显示远端单极 EGM 发生重大变化。在 RFA 过程中，消融序列结束时负峰值幅度降低了 104%，最大负偏转减少了 88%。这些变化主要发生在消融开始后的前 10 秒内。模拟单极 EGM 再现了临床变化，透壁病变的负峰值振幅降低了 83%，最大负偏转降低了 80%。在未来的研究中，所建立的模型可能能够为透壁病变甚至复杂的几何形状制定进一步的 EGM 标准，以支持临床治疗。
Radiofrequency ablation (RFA) therapy is the gold standard in interventional treatment of many cardiac arrhythmias. A major obstacle is nontransmural lesions, leading to recurrence of arrhythmias. Recent clinical studies have suggested intracardiac electrogram (EGM) criteria as a promising marker to evaluate lesion development. Seeking for a deeper understanding of underlying mechanisms, we established a simulation approach for acute RFA lesions. Ablation lesions were modeled by a passive necrotic core surrounded by a borderzone with properties of heated myocardium. Herein, conduction velocity and electrophysiological properties were altered. We simulated EGMs during RFA to study the relation between lesion formation and EGM changes using the bidomain model. Simulations were performed on a three-dimensional setup including a geometrically detailed representation of the catheter with highly conductive electrodes. For validation, EGMs recorded during RFA procedures in five patients were analyzed and compared to simulation results. Clinical data showed major changes in the distal unipolar EGM. During RFA, the negative peak amplitude decreased up to 104% and maximum negative deflection was up to 88% smaller at the end of the ablation sequence. These changes mainly occurred in the first 10 s after ablation onset. Simulated unipolar EGMs reproduced the clinical changes, reaching up to 83% negative peak amplitude reduction and 80% decrease in maximum negative deflection for transmural lesions. In future studies, the established model may enable the development of further EGM criteria for transmural lesions even for complex geometries in order to support clinical therapy.