Quallich Stephen G, Van Heel Michael, Iaizzo Paul A
Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota.
Heart Rhythm. 2015 Feb;12(2):291-6. doi: 10.1016/j.hrthm.2014.11.028. Epub 2014 Nov 24.
Catheter perforations remain a major clinical concern during ablation procedures for treatment of atrial arrhythmias and may lead to life-threatening cardiac tamponade. Radiofrequency (RF) ablation alters the biomechanical properties of cardiac tissue, ultimately allowing for perforation to occur more readily. Studies on the effects of cryoablation on perforation force as well as studies defining the perforation force of human tissue are limited.
The purpose of this study was to investigate the required force to elicit perforation of cardiac atrial tissue after or during ablation procedures.
Effects of RF or cryothermal ablations on catheter perforation forces for both swine (n = 83 animals, 530 treatments) and human (n = 8 specimens, 136 treatments) cardiac tissue were investigated.
Overall average forces resulting in perforation of healthy unablated tissue were 406g ± 170g for swine and 591g ± 240g for humans. Post-RF ablation applications considerably reduced these forces to 246g ± 118g for swine and 362 ± 185g for humans (P <.001). Treatments with cryoablation did not significantly alter forces required to induce perforations. Decreasing catheter sizes resulted in a reduction in forces required to perforate the atrial wall (P <.001). Catheter perforations occurred over an array of contact forces with a minimum of 38g being observed.
The swine model likely underestimates the required perforation forces relative to those of human tissues. We provide novel insights related to the comparative effects of RF and cryothermal ablations on the potential for inducing undesired punctures, with RF ablation reducing perforation force significantly. These data are insightful for physicians performing ablation procedures as well as for medical device designers.
在治疗房性心律失常的消融手术过程中，导管穿孔仍是一个主要的临床问题，可能导致危及生命的心脏压塞。射频（RF）消融会改变心脏组织的生物力学特性，最终使穿孔更容易发生。关于冷冻消融对穿孔力的影响以及确定人体组织穿孔力的研究有限。
本研究的目的是调查在消融手术期间或之后引起心房组织穿孔所需的力。
研究了射频或冷冻消融对猪（n = 83只动物，530次治疗）和人（n = 8个标本，136次治疗）心脏组织导管穿孔力的影响。
导致健康未消融组织穿孔的总体平均力，猪为406g±170g，人 为591g±240g。射频消融术后，这些力大幅降低，猪为246g±118g，人 为362±185g（P<.001）。冷冻消融治疗并未显著改变诱导穿孔所需的力。导管尺寸减小导致穿透心房壁所需的力降低（P<.001）。导管穿孔发生在一系列接触力范围内，观察到的最小力为38g。
相对于人体组织，猪模型可能低估了所需的穿孔力。我们提供了有关射频和冷冻消融对诱发意外穿刺可能性的比较影响的新见解，射频消融显著降低了穿孔力。这些数据对进行消融手术的医生以及医疗设备设计师具有参考价值。
