DETERMINANTS OF LESION SIZE DURING RADIOFREQUENCY CATHETER ABLATION THE ROLE OF ELECTRODE-TISSUE CONTACT PRESSURE AND DURATION OF ENERGY DELIVERY
DETERMINANTS OF LESION SIZE DURING RADIOFREQUENCY CATHETER ABLATION THE ROLE OF ELECTRODE-TISSUE CONTACT PRESSURE AND DURATION OF ENERGY DELIVERY
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DOI：
10.1111/j.1540-8167.1991.tb01353.x
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发表时间：
1991-01-01
影响因子：
2.7
通讯作者：
HAINES D E
中科院分区：
文献类型：
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作者：
HAINES D E
简介：射频导管消融是治疗心律失常的一种有前途的方法，但能量输送的最佳方案尚未确定。本研究旨在检查不同电极-组织接触压力和不同射频能量输送持续时间对离体灌注和灌流犬心肌体外模型中所得病变大小的影响。方法和结果：射频功率（500 kHz）通过安装在可调节支点上的专门设计的1.6 mm直径电极的尖端输送，以便可以改变接触力。调节RF功率以保持恒定的电极-组织界面温度80 ℃。C在病变产生期间。使用90秒射频能量输送和0 - 400牛顿（N）（0-41 g）的贴靠力创建了79处损伤。小贴靠力（10 N）产生的病变明显大于贴靠力为0的病变（宽度5.5 mm vs 3.8 mm，P < 0.0002），但与最大贴靠力400 N产生的病变（宽度6.5 mm，P = NS）无显著差异。然而，较大的接触力显著降低了维持恒定电极-组织界面温度所需的功率。然后使用恒定的贴靠力创建96个损伤，但能量输送的持续时间从10秒到600秒不等。病变大小随时间呈单指数增长。病变生长的t1/2深度和宽度分别为7.6和9.6秒。结论：因此，在心肌射频消融期间，电极-组织紧密接触对于充分形成损伤至关重要，但如果调整功率以维持恒定的电极-组织界面温度，则增加接触力不会显著增加损伤尺寸。为了接近稳态并最大化病变尺寸，射频能量输送的持续时间应至少为40秒。
Introduction: Radiofrequency (RF) catheter ablation is a promising modality in the management of cardiac arrhythmias, but the optimum protocol for energy delivery has not yet been determined. The purpose of this study was to examine the effects of varying electrode-tissue contact pressure and varying duration of RF energy delivery on the size of the resultant lesion in an in vitro model of isolated perfused and superfused canine myocardium. Methods and Results: RF power (500 kHz) was delivered through the tip of a specially-designed thermistor-tipped 1.6-mm diameter electrode mounted on an adjustable fulcrum so that contact force could be varied. RF power was adjusted to maintain a constant electrode-tissue interface temperature of 80.degree. C during lesion production. Seventy-nine lesions were created with a 90-second RF energy delivery, and a contact force that was varied between 0 and 400 newtons (N) (0-41 g). Lesions produced with a small contact force (10 N) were significantly larger than those with a contact force of zero (width 5.5 mm vs 3.8 mm, P < 0.0002), but not significantly different from those produced with the maximum contact force of 400 N (width 6.5 mm, P = NS). However, the greater contact force significantly decreased the power required to maintain a constant electrode-tissue interface temperature. Ninety-six lesions were then created using a constant contact force, but duration of energy delivery was varied from 10 to 600 seconds. Lesion size grew monoexponentially with time. The t1/2 of lesion growth was 7.6 and 9.6 seconds for depth and width, respectively. Conclusion: Thus, close electrode-tissue contact is essential for adequate lesion formation during RF ablation of myocardium, but increasing contact force does not significantly increase lesion size if power is adjusted to maintain a constant electrode-tissue interface temperature. In order to approach steady-state and maximize lesion size, duration of RF energy delivery should be at least 40 seconds.