Schwartzman D, Parizhskaya M, Devine W A
Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, PA, USA.
J Interv Card Electrophysiol. 2001 Mar;5(1):17-26. doi: 10.1023/a:1009897506020.
To characterize the electrophysiologic and histologic sequelae of linear atrial ablation utilizing an irrigated electrode. To compare "irrigated" lesions with lesions deployed using the same electrode in a non-irrigated mode.
Previous reports of radiofrequency catheter ablation using an irrigated electrode have emphasized its favorable effect on lesion depth. We hypothesized that electrode irrigation would also benefit linear ablation of smooth atrial myocardium, a relatively superficial target.
In healthy pigs, lesions were deployed in the right and left atria. Acutely, lesions resulting from ablation using an irrigated electrode, with radiofrequency energy titration guided by electrogram amplitude reduction, were compared to lesions using the same electrode without irrigation, with energy titration guided by electrode thermometry. Irrigated lesions were also assessed serially.
Acutely, irrigated lesions formed complete conduction barriers and were uncomplicated. In contrast, non-irrigated lesions formed complete conduction barriers but were frequently complicated, exhibiting endocardial charring, barotrauma, and pericardial damage. The rate and pattern of histologic evolution of irrigated lesions were uniform throughout each lesion; right and left atrial lesions healed similarly. During healing, 90 % of lesions remained complete conduction barriers and 10 % manifested single discrete conduction gaps where viable appearing myocytes bridged the lesion.
Complete, uncomplicated linear lesions could be reliably deployed in either atrium with an irrigated electrode. Not all lesions remained complete barriers to conduction during their histologic evolution. Lesions deployed with the same electrode in a non-irrigated mode were complete but frequently complicated.
描述使用灌注电极进行线性心房消融的电生理和组织学后遗症。比较“灌注”损伤与使用同一电极在非灌注模式下形成的损伤。
先前关于使用灌注电极进行射频导管消融的报告强调了其对损伤深度的有利影响。我们假设电极灌注也将有利于对相对表浅的光滑心房心肌进行线性消融。
在健康猪中，在右心房和左心房形成损伤。急性情况下，将使用灌注电极消融并由电图幅度降低引导射频能量滴定所形成的损伤，与使用同一电极但不进行灌注并由电极温度测定引导能量滴定所形成的损伤进行比较。还对灌注损伤进行了连续评估。
急性情况下，灌注损伤形成了完整的传导屏障且无并发症。相比之下，非灌注损伤形成了完整的传导屏障，但经常出现并发症，表现为心内膜炭化、气压伤和心包损伤。灌注损伤在每个损伤部位的组织学演变速率和模式是一致的；右心房和左心房的损伤愈合情况相似。在愈合过程中，90%的损伤仍为完整的传导屏障，10%表现为单个离散的传导间隙，其中可见存活的心肌细胞跨越损伤部位。
使用灌注电极可在任一心房可靠地形成完整、无并发症的线性损伤。并非所有损伤在其组织学演变过程中都保持对传导的完整屏障作用。使用同一电极在非灌注模式下形成的损伤是完整的，但经常出现并发症。
