Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.
First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic.
J Cardiovasc Electrophysiol. 2020 May;31(5):1128-1136. doi: 10.1111/jce.14407. Epub 2020 Mar 2.
Despite technical progress, ventricular tachycardia (VT) recurrence after unipolar ablation remains relatively high (12%-47%). Bipolar ablation has been proposed as an appealing solution that may overcome limitations associated with unipolar ablation settings. We designed an animal study to compare bipolar (BPA) vs sequential unipolar ablation (UPA) using contact force-sensing technology on both ablation catheters.
Twenty large white female pigs (6-months-old, 50-60 kg) underwent multiple RF ablations (30 W, 60 seconds, 30 mL/min irrigation) on the ventricular myocardium from the epicardial and endocardial sides. The hearts were fixed and scanned with high-resolution cardiac magnetic resonance imaging. Thermal lesions were located and characterized in volume, depth, width, and transmurality.
Lesion volume was calculated as the sum of epicardial or endocardial conjoined/isolated lesions at one location. Linear dimensions (width and depth) were measured twice for each location, on the endocardial and epicardial side. We evaluated 35 lesions across the intraventricular septum (UPA, N = 17 vs BPA, N = 18). No difference in volume, linear dimensions or impedance drop was observed in this area between UPA and BPA. However, BPA required half RF time and showed an increased transmurality trend. We then analyzed 73 lesions from the endocardial side (UPA, N = 35 vs BPA, N = 38) and 50 from the epicardial side (UPA, N = 11 vs BPA N = 39) of the ventricular free walls. Lesion transmurality was markedly improved by BPA (P = .030, odds ratio, 23.73 [4.71,31.96]). Ventricular BPA lesions were significantly deeper on the epicardial side (P < .0001) and endocardial side (P = .015).
Bipolar ablation is more likely to create transmural and epicardial lesions in the ventricle wall. Half the time is needed for the creation of comparably deep and large lesions.
尽管技术取得了进步，但单极消融后室性心动过速（VT）的复发率仍然相对较高（12%-47%）。双极消融已被提出作为一种有吸引力的解决方案，可能克服与单极消融设置相关的局限性。我们设计了一项动物研究，使用两种消融导管上的接触力感应技术比较双极（BPA）与顺序单极消融（UPA）。
20 只大白母猪（6 月龄，50-60kg）在心外膜和心内膜侧进行多次射频消融（30W，60 秒，30mL/min 灌流）。心脏固定后用高分辨率心脏磁共振成像扫描。定位并在体积、深度、宽度和透壁性方面对热损伤进行特征描述。
损伤体积计算为一个部位的心外膜或心内膜联合/孤立损伤的总和。线性尺寸（宽度和深度）在每个部位心内膜和心外膜侧测量两次。我们评估了 35 个跨室间隔病变（UPA，N=17 例 vs BPA，N=18 例）。在该区域，UPA 和 BPA 之间在体积、线性尺寸或阻抗下降方面没有差异。然而，BPA 需要一半的 RF 时间，并且显示出透壁性增加的趋势。然后，我们分析了心内膜侧的 73 个病变（UPA，N=35 例 vs BPA，N=38 例）和心外膜侧的 50 个病变（UPA，N=11 例 vs BPA，N=39 例）。BPA 明显改善了损伤的透壁性（P=0.030，优势比 23.73[4.71，31.96]）。BPA 下心室壁的损伤在心外膜侧（P<0.0001）和心内膜侧（P=0.015）明显更深。
双极消融更有可能在心壁上形成透壁和心外膜损伤。创建类似深度和大的损伤所需的时间减半。
