Impedance-decline-guide power control long application time bipolar radiofrequency catheter ablation
Impedance-decline-guide power control long application time bipolar radiofrequency catheter ablation
复制标题
阻抗下降引导功率控制长应用时间双极射频导管消融
DOI：
10.1111/jce.15684
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Chinushi M.
中科院分区：
文献类型：
--
作者：
Saitoh O;Kasai T;Fuse K;Oikawa A;Furushima H;Chinushi M.
介绍双极（BIP）射频（RF）消融可造成深部心肌损伤，但治疗起源于厚心肌深部的室性心律失常的理想能量应用模式尚未建立。进行了一项实验研究，以阐明阻抗下降引导功率控制（PC）是否可执行高功率和长应用时间的BIP消融，以及它是否可以在最小蒸汽爆裂风险的情况下在厚心室中创建透壁损伤。方法和结果灌注猪心室（18.4 ± 2.3 mm）放置在实验浴中，使用两种方案（固定功率（FP）和阻抗下降引导PC），在30 g的导管接触下尝试BIP消融（50 W）120 s。在后一种方案中，BIP消融从50 W开始，而根据射频消融过程中的阻抗下降，将能量降至40 - 20 W。在30次应用中尝试FP消融，所有30次均创建了透壁损伤，但16/30次应用（53%）发生了蒸汽爆裂。低的最小阻抗、大的总阻抗下降（TID）和%-TID与蒸汽爆裂的发生相关。在另外21例应用中尝试了PC消融，在所有21例应用中均创建了透壁损伤，未发生蒸汽爆裂。PC消融优于FP消融（21/21 vs. 14/30，p <.001）在创建透壁损伤而不导致steam-pop. ConclusionsHigh power and long application time BIP消融似乎是可行的，根据阻抗下降指南的方法，它可以创建透壁损伤厚猪心室与最小的风险steam-pop。
IntroductionBipolar (BIP) radiofrequency (RF) ablation creates deep myocardial lesions but ideal energy application modes to treat ventricular arrhythmias originating from deep inside the thick myocardium have not been well established. An experimental study was performed to clarify whether high power and long application time BIP ablation were performable by impedance‐decline‐guide power control (PC) and whether it could create transmural lesions in the thick ventricle with a minimum risk of steam‐pop.Methods and ResultsPerfused porcine ventricle (18.4 ± 2.3 mm) was placed in an experimental bath and BIP ablation (50 W) for 120 s was attempted with catheter contact of 30‐g using two protocols; fixed power (FP) and impedance‐decline‐guide PC. In the latter protocol, BIP ablation was started from 50 W, while the energy was decreased to 40–20 W according to the impedance decline during RF ablation. FP ablation was attempted in 30 applications and the transmural lesion was created in all 30, although steam‐pop occurred in 16/30 applications (53%). Low minimum impedance, large total impedance decline (TID), and %‐TID were associated with the steam‐pop occurrence. PC ablation was attempted in another 21 applications, and the transmural lesion was created in all 21 without steam‐pop. PC ablation was superior to FP ablation (21/21 vs. 14/30,p< .001) in the creation of a transmural lesion without resulting in steam‐pop.ConclusionsHigh power and long application time BIP ablation seems to be feasible according to the impedance‐decline‐guide approach, which could create transmural lesions in thick porcine ventricles with minimal risk of steam‐pop.