Ohkubo Kimie, Watanabe Ichiro, Okumura Yasuo, Kofune Masayoshi, Nagashima Koichi, Sonoda Kazumasa, Mano Hiroaki, Nakai Toshiko, Kunimoto Satoshi, Kasamaki Yuji, Hirayama Atsushi
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Int Heart J. 2012;53(2):129-32. doi: 10.1536/ihj.53.129.
The stepwise approach to radiofrequency (RF) ablation of atrial fibrillation (AF) can include ablation of the coronary sinus (CS) by RF delivery at the left atrium (LA) and/or within the CS. In both cases, the energy is applied between the tip electrode of a percutaneous catheter and a dispersive electrode on the body surface. We explored the feasibility of using the electrode rings of a diagnostic catheter placed in the CS as dispersive electrode(s) for RF delivery within the LA and compared this technique to an established CS ablation method.Excised pig hearts were superfused with a pulsatile saline flow. Bipolar ablation was performed between a saline-irrigated (20 mL/minute) 4-mm tip electrode placed in the LA adjacent to the CS and 7 electrode rings of a 6F, septapolar, 4-mm nonirrigated electrode placed within the CS adjacent to the LA endocardial electrode. Unipolar ablation was performed between the endocardial electrode and dispersive electrode. A continuous transmural lesion was produced in 6/8 (75%) attempts with bipolar ablation, but in 0/6 (0%) attempts with unipolar ablation. However, the incidence of steam pop tended to be increased with bipolar ablation.Bipolar ablation of the CS appears to be highly effective for creating a transmural LA-CS lesion.
心房颤动（AF）射频（RF）消融的逐步方法可包括通过在左心房（LA）和/或冠状窦（CS）内进行RF传递来消融CS。在这两种情况下，能量都施加在经皮导管的尖端电极与体表上的分散电极之间。我们探讨了将置于CS中的诊断导管的电极环用作LA内RF传递的分散电极的可行性，并将该技术与既定的CS消融方法进行了比较。切除的猪心脏用脉动盐水流进行灌注。在置于LA中与CS相邻的盐水灌注（20毫升/分钟）4毫米尖端电极与置于CS中与LA心内膜电极相邻的6F、七极、4毫米非灌注电极的7个电极环之间进行双极消融。在心内膜电极与分散电极之间进行单极消融。双极消融在6/8（75%）的尝试中产生了连续的透壁损伤，但单极消融在0/6（0%）的尝试中未产生。然而，双极消融时蒸汽泡的发生率有增加趋势。CS的双极消融似乎对于形成LA-CS透壁损伤非常有效。
