Debruyne Philippe, Rossenbacker Tom, Vankelecom Bart, Charlier Filip, Roosen John, Ector Bavo, Janssens Luc
Imelda Hospital, Bonheiden, Belgium.
Pacing Clin Electrophysiol. 2014 Feb;37(2):188-96. doi: 10.1111/pace.12256. Epub 2013 Sep 11.
Radiofrequency ablation (RFA) can unfavorably cause coagulum on the ablation electrode. The aim of this study was to assess this phenomenon on three different multielectrode catheters used to treat persistent atrial fibrillation with duty-cycled RFA.
Twenty-six consecutive patients have been treated with the pulmonary vein ablation catheter (PVAC) and the multiarray ablation catheter (MAAC). In 13 patients, additional ablation with the multiarray septal catheter (MASC) has been performed. The multichannel RF generator GENius™ (Medtronic Inc., Minneapolis, MN, USA) independently delivered energy in a bipolar and unipolar mode (ratio of 4/1, 2/1, or 1/1) to any of the electrodes. Versions 14.2, 14.3, and 14.4 of the generator were used. Coagulum presence was determined postablation by careful visual inspection of the catheter electrodes. No coagulum formation was visualized on the PVACs. Coagulum formation was visualized in 59% of the electrodes of the MAACs using a 2/1 mode and the 14.2 software version versus 69% using the 14.4 version and a 2/1 mode (P = 0.7) versus 14% of the electrodes applying a 1/1 ratio and the 14.4 software version (P < 0.001).
Duty-cycled RFA in 2/1 bipolar/unipolar ratio generates a substantial frequency of coagulum formation on the multielectrode catheters MAAC and MASC. The use of the 14.4 version of the software to drive the RF generator and the use of energy in the default 1/1 bipolar/unipolar ratio could significantly reduce the frequency of coagulum formation, but so far, could not completely overcome it. The PVAC did not form coagulum, regardless of generator version or energy ratio used.
射频消融（RFA）可能会在消融电极上不利地形成凝块。本研究的目的是评估使用占空比RFA治疗持续性房颤的三种不同多电极导管上的这种现象。
连续26例患者接受了肺静脉消融导管（PVAC）和多阵列消融导管（MAAC）治疗。13例患者还使用多阵列间隔导管（MASC）进行了额外消融。多通道射频发生器GENius™（美敦力公司，明尼阿波利斯，明尼苏达州，美国）以双极和单极模式（4/1、2/1或1/1的比例）独立地向任何电极输送能量。使用了该发生器的14.2、14.3和14.4版本。消融后通过仔细目视检查导管电极来确定凝块的存在情况。在PVAC上未观察到凝块形成。使用2/1模式和14.2软件版本时，MAAC的电极中有59%观察到凝块形成；使用14.4版本和2/1模式时，这一比例为69%（P = 0.7）；而使用1/1比例和14.4软件版本时，电极中有14%观察到凝块形成（P < 0.001）。
2/1双极/单极比例的占空比RFA在多电极导管MAAC和MASC上产生凝块形成的频率较高。使用14.4版本的软件驱动射频发生器以及使用默认的1/1双极/单极比例的能量可显著降低凝块形成的频率，但到目前为止，尚不能完全克服这一问题。无论使用何种发生器版本或能量比例，PVAC均未形成凝块。
