Helmsley Electrophysiology Center, Mount Sinai Medical Center, New York, New York.
Helmsley Electrophysiology Center, Mount Sinai Medical Center, New York, New York.
JACC Clin Electrophysiol. 2017 Oct;3(10):1092-1102. doi: 10.1016/j.jacep.2017.08.008. Epub 2017 Oct 16.
This study sought to compare a novel lesion dimension estimation approach to actual measurements of lesion dimensions on necropsy in porcine atria and ventricles.
An irrigated-tip, force-sensing radiofrequency catheter with 6 temperature (tip-tissue interface) sensors allows for assessment of lesion dimensions based on estimated tissue temperature. Lesion dimension assessment has not been attempted previously in atrial tissue.
Ablations were performed using this catheter in all chambers. Irrigated radiofrequency was delivered using 20 to 50 W for durations that ranged from 15 to 90 s with contact force ranging from 5 to 45 g to replicate a wide spectrum of clinical conditions. All swine were then sacrificed and lesions were identified and photographed. Three independent observers made offline measurements, which were then averaged to obtain lesion width and depth for comparison with estimated dimensions based on interface tissue temperature.
In 9 swine, 54 atrial and 61 ventricular lesions were assessed. In the atria, the mean difference between the measured and estimated depth and width was 0.9 ± 0.74 mm and 1.2 ± 0.9 mm, respectively. Eighty percent of all lesions had a difference of ≤1.7 mm for depth and ≤1.74 mm for width. In the ventricle, the mean difference between the measured and estimated depth and width was 0.75 ± 0.6 mm and 1.66 ± 1.1 mm, respectively. Eighty percent of all lesions had a difference of ≤1.1 mm ventricular depth and ≤2.6 mm for width.
Estimation of lesion dimensions can be achieved with clinically relevant accuracy using unique temperature signatures. These data have important implications for understanding the adequacy of lesion overlap and assessment of transmurality.
本研究旨在比较一种新的病变尺寸估计方法与猪心耳和心室尸检实际测量的病变尺寸。
一种带有 6 个温度（尖端-组织界面）传感器的灌流尖端、力感应射频导管允许根据估计的组织温度评估病变尺寸。以前尚未尝试在心耳组织中进行病变尺寸评估。
在所有心腔中使用该导管进行消融。使用 20 至 50 W 的灌流射频，持续时间从 15 秒到 90 秒不等，接触力范围从 5 克到 45 克，以模拟广泛的临床情况。所有猪随后被处死，识别并拍摄病变。三名独立观察者进行离线测量，然后取平均值，以获得病变宽度和深度，与基于界面组织温度的估计尺寸进行比较。
在 9 头猪中，评估了 54 个心房和 61 个心室病变。在心耳中，测量的和估计的深度和宽度之间的平均差异分别为 0.9 ± 0.74 毫米和 1.2 ± 0.9 毫米。80%的所有病变在深度上的差异为 ≤1.7 毫米，在宽度上的差异为 ≤1.74 毫米。在心室中，测量的和估计的深度和宽度之间的平均差异分别为 0.75 ± 0.6 毫米和 1.66 ± 1.1 毫米。80%的所有心室病变在深度上的差异为 ≤1.1 毫米，在宽度上的差异为 ≤2.6 毫米。
使用独特的温度特征，可以以临床相关的准确性估计病变尺寸。这些数据对于理解病变重叠的充分性和评估透壁性具有重要意义。
