Impedance, power, and current in radiofrequency ablation: Insights from technical, ex vivo, and clinical studies
Impedance, power, and current in radiofrequency ablation: Insights from technical, ex vivo, and clinical studies
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DOI：
10.1111/jce.14709
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发表时间：
2020-08-13
影响因子：
2.7
通讯作者：
Jais, Pierre
中科院分区：
文献类型：
--
作者：
Bourier, Felix;Ramirez, Francisco Daniel;Jais, Pierre
背景射频（RF）功率在射频应用过程中被常规考虑。相比之下，阻抗的研究相对较少，尽管它也会影响射频损伤的形成。本研究的目的是检查电阻抗对射频损伤特征和临床射频消融参数的影响。方法和结果在研究的第一部分中，系统地改变功率和阻抗，并使用定制的软件计算产生的电流。在研究的第二部分，在猪离体模型中分析了消融病变（n = 40）。使用接触力消融导管在具有系统变化的电阻抗值的心肌准备中输送射频应用。在研究的第三部分，分析了n = 3378次临床射频应用，导出了功率、阻抗和电流数据，并与临床患者数据进行了关联。20 +/- 3 W/80 Ω、30 +/- 3 W/120 Ω、40 +/- 3 W/160 Ω和50 +/- 3 W/200 Ω射频应用产生498 +/- 40、499 +/- 26、500 +/- 20和500 +/- 16 mA射频电流，这没有显著差异（p = 0.32）。当施加相同功率但不同阻抗时，消融损伤的深度和直径显著不同（p <0.01）;增加阻抗时，损伤尺寸减小。在临床数据中，大范围的输送电流（例如，39-40 W：530-754 mA）。结论射频损伤的产生是由电流而不是功率决定的。在临床射频消融手术期间，阻抗显著影响电流输送，并且患者之间差异很大。阻抗和电流是射频消融期间应考虑的临床相关参数。
Background Radiofrequency (RF) power is routinely considered during RF application. In contrast, impedance has been relatively poorly studied, despite also influencing RF lesion creation. The aim of this study was to examine the influence of electric impedance on RF lesion characteristics and on clinical RF ablation parameters. Methods and Results In the first part of the study, power and impedance were systematically varied and the resulting current was calculated using custom-made software. In the second part of the study, ablation lesions (n = 40) were analyzed in a porcine ex vivo model. RF applications were delivered in cardiac muscle preparations with systematically varied values of electric impedance using a contact force ablation catheter. In the third part of the study,n = 3378 clinical RF applications were analyzed, power, impedance, and current data were exported and correlated with clinical patient data. 20 +/- 3 W/80 omega, 30 +/- 3 W/120 omega, 40 +/- 3 W/160 omega, and 50 +/- 3 W/200 omega RF applications resulted in 498 +/- 40, 499 +/- 26, 500 +/- 20, and 500 +/- 16 mA RF current, which were not significantly different (p = .32). Ablation lesions were significantly different in depth and diameter when applied with the same power but different impedances (p < .01); lesion sizes decreased when increasing impedance. In clinical data, a large range of delivered current (e.g., 39-40 W: 530-754 mA) was measured, due to variations in impedance. Conclusions RF lesion creation is determined by current rather than by power. During clinical RF ablation procedures, impedance significantly influences current delivery and varies considerably between patients. Impedance and current are clinically relevant parameters that should be considered during RF ablation.