Nguyen Duy T, Tzou Wendy S, Brunnquell Michael, Zipse Matthew, Schuller Joseph L, Zheng Lijun, Aleong Ryan A, Sauer William H
Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado.
Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado.
Heart Rhythm. 2016 Nov;13(11):2161-2171. doi: 10.1016/j.hrthm.2016.07.011. Epub 2016 Jul 14.
Bipolar radiofrequency ablation (bRFA) has been used to create larger ablation lesions and to treat refractory arrhythmias. However, little is known about optimal bRFA settings.
The purpose of this study was to evaluate various bRFA settings, including active and ground catheter tip orientation and use of variable active and ground catheters during bRFA.
Two ablation catheters, 1 active and 1 ground, were oriented across from each other, with viable bovine myocardium in between. The catheter tips were placed in various combinations perpendicular or parallel to the myocardium. The active catheter was either a 3.5-mm externally irrigated or 8-mm tip, and the ground catheter was either a 4-mm, 3.5-mm irrigated, or 8-mm tip. Retrospective analysis was undertaken for all bRFA performed at University of Colorado.
The largest and deepest lesions were produced using irrigated active and ground tips, oriented perpendicularly. In 14 cases (10 patients) of bRFA for ventricular tachycardia and premature ventricular complexes, acute success was achieved in 13 of 14 procedures. Long-term success was achieved in 7 of 10 patients, but 3 patients required multiple bRFA ablations.
Active and ground catheter tip orientation and type are important determinants of lesion sizes during bRFA. The largest and deepest lesions, without a higher incidence of steam pops, were achieved using 2 irrigated catheters. As the largest published series to date, bRFA ablation can be performed safely and effectively in humans. Larger studies are necessary to better evaluate bRFA efficacy and safety.
双极射频消融术（bRFA）已被用于制造更大的消融灶并治疗难治性心律失常。然而，对于最佳的bRFA设置知之甚少。
本研究的目的是评估各种bRFA设置，包括消融电极和接地电极尖端的方向以及在bRFA期间使用可变的消融电极和接地电极。
两根消融导管，一根消融电极和一根接地电极，彼此相对放置，中间为存活的牛心肌。导管尖端以各种组合垂直或平行于心肌放置。消融电极要么是3.5毫米外部灌注电极，要么是8毫米尖端电极，接地电极要么是4毫米、3.5毫米灌注电极，要么是8毫米尖端电极。对科罗拉多大学进行的所有bRFA进行回顾性分析。
使用垂直放置的灌注消融电极和接地电极尖端产生了最大和最深的病灶。在14例（10名患者）用于室性心动过速和室性早搏的bRFA中，14例手术中有13例取得了急性成功。10名患者中有7名取得了长期成功，但3名患者需要多次bRFA消融。
消融电极和接地电极尖端的方向和类型是bRFA期间病灶大小的重要决定因素。使用两根灌注导管可实现最大和最深的病灶，且蒸汽泡发生率不会更高。作为迄今为止已发表的最大系列研究，bRFA消融术可在人体中安全有效地进行。需要进行更大规模的研究以更好地评估bRFA的疗效和安全性。
