Seiler Jens, Roberts-Thomson Kurt C, Raymond Jean-Marc, Vest John, Delacretaz Etienne, Stevenson William G
The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Heart Rhythm. 2008 Oct;5(10):1411-6. doi: 10.1016/j.hrthm.2008.07.011. Epub 2008 Jul 10.
Steam pops are a risk of irrigated radiofrequency catheter ablation (RFA) and may cause cardiac perforation. Data to guide radiofrequency (RF) energy titration to avoid steam pops are limited.
This study sought to assess the frequency and consequence of audible pops and to determine the feasibility of using the magnitude of impedance change to predict pops.
We reviewed consecutive endocardial open-irrigated RFA for ventricular tachycardia (VT) with continuously recorded ablation data in 142 patients with structural heart disease. Steam pops were defined as an audible pop associated with a sudden spike in impedance. Ablation lesions before or after pops served as controls.
From a total of 4,107 ablation lesions, 62 (1.5%) steam pops occurred in 42 procedures in 38 patients. Perforation with tamponade occurred with 1 of 62 (2%) pops. Applications with pops had a greater impedance decrease (22 +/- 7 Omega vs. 18 +/- 8 Omega, P = .001) and a higher maximum power (45 +/- 5 W vs. 43 +/- 6 W, P = .011), but did not differ in maximum catheter tip temperature (40 degrees C +/- 4 degrees C vs. 40 degrees C +/- 4 degrees C, P = .180) from applications without pops. Eighty percent of pops occurred after impedance decreased by at least 18 Omega.
During VT ablation with open irrigation, audible pops are infrequent and do not usually cause perforation. Limiting RF power to achieve an impedance decrease of <18 Omega is a feasible method of reducing the likelihood of a pop when perforation risk is of concern.
蒸汽爆鸣声是灌注式射频导管消融术（RFA）的一种风险，可能导致心脏穿孔。指导射频（RF）能量滴定以避免蒸汽爆鸣声的数据有限。
本研究旨在评估可闻爆鸣声的频率和后果，并确定使用阻抗变化幅度预测爆鸣声的可行性。
我们回顾了142例患有结构性心脏病的患者连续进行的心内膜开放式灌注RFA治疗室性心动过速（VT）的情况，术中连续记录消融数据。蒸汽爆鸣声定义为与阻抗突然尖峰相关的可闻爆鸣声。爆鸣声前后的消融病灶作为对照。
在总共4107个消融病灶中，38例患者的42次手术中出现了62次（1.5%）蒸汽爆鸣声。62次爆鸣声中有1次（2%）发生了心包填塞穿孔。出现爆鸣声的应用中阻抗下降更大（22±7Ω对18±8Ω，P = 0.001），最大功率更高（45±5W对43±6W，P = 0.011），但与未出现爆鸣声的应用相比，导管尖端最高温度无差异（40℃±4℃对40℃±4℃，P = 0.180）。80%的爆鸣声发生在阻抗至少下降18Ω之后。
在开放式灌注VT消融过程中，可闻爆鸣声不常见，通常不会导致穿孔。当关注穿孔风险时，限制RF功率以使阻抗下降<18Ω是降低爆鸣声发生可能性的一种可行方法。
