Cardiovascular Institute, Padeh Medical Center, Bar Ilan University Medical School, Poriya, Israel.
Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Europace. 2018 Nov 1;20(FI_3):f444-f450. doi: 10.1093/europace/euy031.
Delivery of high-power short-duration radiofrequency (RF) ablation lesions is not commonly used, in part because conventional thermocouple (TC) technology underestimates tissue temperature, increasing the risk of steam pop, and thrombus formation. We aimed to test whether utilization of an ablation catheter equipped with a highly accurate novel TC technology could facilitate safe and effective delivery of high-power RF lesions.
Adult male Yorkshire swine were used for the study. High-power short-duration ablations (10-s total; 90 W for 4 s followed by 50 W for 6 s) were delivered using an irrigated force sensing catheter, equipped with six miniature TC sensors embedded in the tip electrode shell. Power modulation was automatically performed when the temperature reached 65°C. Ablation parameters were recorded and histopathological analysis was performed to assess lesion formation. One hundred and fourteen RF applications, delivered using the study ablation protocol in the ventricles of eight swine [53 in the right ventricle (RV), 61 in the left ventricle (LV)], were analysed. Average power delivered was 55.4 ± 5.3 W and none of the ablations resulted in a steam pop. Fourteen out of the 114 (12.3%) lesions were transmural. The mean lesion depth was 3.9 ± 1.1 mm for the 100 non-transmural lesions. Similar ablation parameters resulted in bigger impedance drop (11.6 Ω vs. 9.1 Ω, P = 0.009) and deeper lesions in the LV compared with the RV (4.3 ± 1.2 mm vs. 3.3 ± 0.8 mm, P < 0.001).
Delivery of high-power short-duration RF energy applications, facilitated by a novel ablation catheter system equipped with advanced TC technology, is feasible, safe, and results in the formation of effective ablation lesions.
高强度短时间射频（RF）消融治疗并不常用，部分原因是传统的热电偶（TC）技术低估了组织温度，增加了蒸汽爆发和血栓形成的风险。我们旨在测试一种配备高度准确的新型 TC 技术的消融导管是否能够安全有效地实施高强度短时间 RF 消融治疗。
本研究使用成年雄性约克夏猪。使用配备六根微型 TC 传感器的灌流力感知导管进行高强度短时间消融（总 10 秒；4 秒时 90W，6 秒时 50W）。当温度达到 65°C 时，自动进行功率调制。记录消融参数并进行组织病理学分析以评估消融灶形成情况。在 8 只猪的心室中按照研究消融方案进行了 114 次 RF 应用[右心室（RV）53 次，左心室（LV）61 次]。平均输送功率为 55.4 ± 5.3W，无蒸汽爆发发生。114 个消融灶中有 14 个（12.3%）为穿透性。100 个非穿透性消融灶的平均消融灶深度为 3.9 ± 1.1mm。与 RV 相比，LV 的相似消融参数导致更大的阻抗下降（11.6 Ω 比 9.1 Ω，P=0.009）和更深的消融灶（4.3 ± 1.2mm 比 3.3 ± 0.8mm，P<0.001）。
新型配备先进 TC 技术的消融导管系统有助于实施高强度短时间 RF 能量应用，该方法可行、安全，可形成有效的消融灶。
