Thermal latency adds to lesion depth after application of high-power short-duration radiofrequency energy: Results of a computer-modeling study
Thermal latency adds to lesion depth after application of high-power short-duration radiofrequency energy: Results of a computer-modeling study
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DOI：
10.1111/jce.13363
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发表时间：
2018-02-01
影响因子：
2.7
通讯作者：
Berjano, Enrique
中科院分区：
文献类型：
--
作者：
Irastorza, Ramiro M.;d'Avila, Andre;Berjano, Enrique
前言：利用超短射频脉冲，由于热潜伏期的原因，可以在施加脉冲后立即获得更大的病变深度。方法和结果：建立了灌注式导管射频消融的计算机模型，研究了热潜伏期对病变深度的影响。结果表明，射频脉冲持续时间越短(保持能量恒定)，冷却阶段的损伤深度越大。例如，在10秒脉冲后，病变深度从脉冲结束时的2.05 mm增长到2.39 mm(17%)，而在仅1秒的超短RF脉冲之后，额外增长37%(从2.22 mm到3.05 mm)。重要的是，短脉冲照射比长脉冲照射导致更深的损伤(1秒和10秒脉冲分别为3.05毫米和2.39毫米)。虽然缩短脉冲持续时间会产生更深的损伤，但相关的施加电压的增加会导致组织过热：在1秒和5秒脉冲的情况下，温度约为100摄氏度，深度为1毫米。然而，由于在降温期间病变深度增加，可以在较短的时间内施加较低的电压，以便在避免过热的同时获得与较长持续时间相似的病变深度。结论：热潜伏期现象似乎是短持续时间高功率射频脉冲后病变深度显著增加的原因。当电压和持续时间改变时，平衡施加的总能量不是最佳策略，因为短脉冲也会导致过热。
Introduction: The use of ultra-short RF pulses could achieve greater lesion depth immediately after the application of the pulse due to thermal latency.Methods and results: A computer model of irrigated-catheter RF ablation was built to study the impact of thermal latency on the lesion depth. The results showed that the shorter the RF pulse duration (keeping energy constant), the greater the lesion depth during the cooling phase. For instance, after a 10-second pulse, lesion depth grew from 2.05 mm at the end of the pulse to 2.39 mm (17%), while after an ultra-short RF pulse of only 1 second the extra growth was 37% (from 2.22 to 3.05 mm). Importantly, short applications resulted in deeper lesions than long applications (3.05 mm vs. 2.39 mm, for 1-and 10-second pulse, respectively). While shortening the pulse duration produced deeper lesions, the associated increase in applied voltage caused overheating in the tissue: temperatures around 100 degrees C were reached at a depth of 1 mm in the case of 1-and 5-second pulses. However, since the lesion depth increased during the cooling period, lower values of applied voltage could be applied in short durations in order to obtain lesion depths similar to those in longer durations while avoiding overheating.Conclusion: The thermal latency phenomenon seems to be the cause of significantly greater lesion depth after short-duration high-power RF pulses. Balancing the applied total energy when the voltage and duration are changed is not the optimal strategy since short pulses can also cause overheating.