Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Myocardial Pathophysiology Area (J.M.A.-A., J.G.Q., S.L.-C., J.J., D.F.-R.).
Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).
Circ Arrhythm Electrophysiol. 2019 Mar;12(3):e007080. doi: 10.1161/CIRCEP.118.007080.
Ablation of some myocardial substrates requires catheter-based radiofrequency delivery at the root of a great artery. We studied the safety and efficacy parameters associated with catheter-based radiofrequency delivery at the root of the aorta and pulmonary artery.
Thirty-six pigs underwent in-vivo catheter-based ablation under continuous contact-force and lesion index (power, contact-force, and time) monitoring during 60-s radiofrequency delivery with an open-irrigated tip catheter. Twenty-eight animals were allocated to groups receiving 40 W (n=9), 50 W (n=10), or 60 W (n=9) radiofrequency energy, and acute (n=22) and chronic (n=6) arterial wall damage was quantified by multiphoton microscopy in ex vivo samples. Adjacent myocardial lesions were quantified in parallel samples. The remaining 8 pigs were used to validate safety and efficacy parameters.
Acute collagen and elastin alterations were significantly associated with radiofrequency power, although chronic assessment revealed vascular wall recovery in lesions without steam pop. The main parameters associated with steam pops were median peak temperature >42°C and impedance falls >23 ohms. Unlike other parameters, lesion index values of 9.1 units (interquartile range, 8.7-9.8) were associated with the presence of adjacent myocardial lesions in both univariate ( P=0.03) and multivariate analyses ( P=0.049; odds ratio, 1.99; 95% CI, 1.02-3.98). In the validation group, lesion index values using 40 W over a range of contact-forces correlated with the size of radiofrequency lesions (R=0.57; P=0.03), with no angiographic or histopathologic signs of coronary artery damage.
Lesion index values obtained during 40 W radiofrequency applications reliably monitor safe and effective lesion creation at the root of the great arteries.
消融某些心肌底物需要在大动脉根部进行基于导管的射频传递。我们研究了与主动脉根部和肺动脉根部基于导管的射频传递相关的安全性和有效性参数。
36 头猪在体内进行了基于导管的消融，在使用开放式灌流尖端导管进行 60 秒射频传递时，持续进行接触力和病变指数（功率、接触力和时间）监测。28 只动物分为 40 W（n=9）、50 W（n=10）或 60 W（n=9）射频能量组，在急性（n=22）和慢性（n=6）动脉壁损伤通过离体样本中的多光子显微镜进行量化。相邻心肌病变在平行样本中进行量化。其余 8 头猪用于验证安全性和有效性参数。
急性胶原和弹性蛋白改变与射频功率显著相关，尽管慢性评估显示在没有蒸汽 pop 的病变中血管壁恢复。与蒸汽 pop 相关的主要参数是中值峰值温度>42°C 和阻抗下降>23 欧姆。与其他参数不同，病变指数值为 9.1 个单位（四分位距，8.7-9.8）与单变量分析（P=0.03）和多变量分析（P=0.049；优势比，1.99；95%置信区间，1.02-3.98）中存在相邻心肌病变相关。在验证组中，在 40 W 范围内使用不同接触力时的病变指数值与射频病变的大小相关（R=0.57；P=0.03），并且没有冠状动脉损伤的血管造影或组织病理学迹象。
在 40 W 射频应用过程中获得的病变指数值可靠地监测了大动脉根部的安全有效的病变形成。
