Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, 98000, Monaco.
Europace. 2014 May;16(5):660-7. doi: 10.1093/europace/euu068.
During radiofrequency (RF) delivery, lesion volume is highly dependent on contact force (CF). It has recently been shown that changes of bipolar electrogram (EGM) predict transmurality. We hypothesized that there is a correlation between CF and EGM criteria of transmural lesion (TL) during RF.
We prospectively studied consecutive 512 RF applications from atrial fibrillation ablation procedures. A force-sensing ablation catheter (Tacticath(®), Endosense) was used to continuously measure CF and force-time integral (FTI) during each RF application. Distal bipolar EGM was analysed before, during, and after each RF application. Depending on initial EGM morphology, transmurality of lesions was defined by: (i) disappearance of the positivity after RF when there was QR morphology, (ii) diminution >75% of the positivity when there was QRS morphology, or (iii) disappearance of the R' positivity when there was RSR' morphology. Electrogram criteria were validated by electrophysiologists blinded to force measurements. Force-time integral was higher in TL than in non-transmural lesions (NTLs): 652 ± 248 vs. 212 ± 140 gs (P < 0.001). Mean CF per RF pulse was higher in TL than in NTL: 26.3 ± 12.5 vs. 11.3 ± 10.3 g (P < 0.001). The best cut-off to predict TL was an FTI ≥ 392 gs [sensitivity 0.89, specificity (Sp) 0.93, positive predictive value (PPV) 0.98, and negative predictive value 0.67] and a higher FTI (>700 gs) warrants transmurality of RF atrial lesions (100% Sp and PPV).
Contact force and FTI during RF are correlated with TL. During RF delivery, a target FTI > 392 gs can be used as an endpoint.
在射频（RF）传递过程中，病变体积高度依赖于接触力（CF）。最近的研究表明，双极电图（EGM）的变化可以预测透壁性。我们假设在 RF 过程中 CF 和 EGM 透壁性病变（TL）标准之间存在相关性。
我们前瞻性地研究了连续 512 次房颤消融手术中的 RF 应用。使用力感应消融导管（Tacticath®，Endosense）在每次 RF 应用过程中连续测量 CF 和力-时间积分（FTI）。在每次 RF 应用前后分析远端双极 EGM。根据初始 EGM 形态，通过以下三种方式定义病变的透壁性：（i）当 QR 形态存在时，RF 后正性消失；（ii）当 QRS 形态存在时，正性减少>75%；或（iii）当 RSR'形态存在时，R'正性消失。电生理学家对力测量结果不知情，对 EGM 标准进行了验证。TL 的 FTI 高于非透壁性病变（NTL）：652±248 vs. 212±140 gs（P<0.001）。TL 每 RF 脉冲的平均 CF 高于 NTL：26.3±12.5 vs. 11.3±10.3 g（P<0.001）。预测 TL 的最佳截断值为 FTI≥392 gs [灵敏度 0.89，特异性（Sp）0.93，阳性预测值（PPV）0.98，阴性预测值 0.67]，更高的 FTI（>700 gs）提示 RF 心房病变的透壁性（100%Sp 和 PPV）。
RF 过程中的 CF 和 FTI 与 TL 相关。在 RF 传递过程中，可以将目标 FTI>392 gs 作为终点。
