Internal Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, MS B-136, Aurora, CO 80045, USA.
Cardiac Electrophysiology, University of Colorado School of Medicine, 12401 East 17th Avenue, MS B-136, Aurora, CO 80045, USA.
Card Electrophysiol Clin. 2020 Sep;12(3):401-408. doi: 10.1016/j.ccep.2020.05.006.
Important physiologic and anatomic differences exist between the epicardium and endocardium, particularly of the ventricles, and these differences affect ablation biophysics. Absence of passive convective effects conferred by circulating blood as well as the presence of epicardial fat and vessels and absence of intracavitary ridges and structures affect ablation lesion size when performing epicardial catheter-based ablation, whether using radiofrequency or cryothermal energy. Understanding differential effects in each environment is important in informing strategies to increase ablation lesion depth. When using actively cooled radiofrequency ablation, local impedance can be altered to selectively augment energy delivery.
心外膜和心内膜（尤其是心室）之间存在重要的生理和解剖差异，这些差异会影响消融的生物物理学特性。由于缺乏循环血液带来的被动对流效应，以及心外膜脂肪和血管的存在，以及心腔内无嵴和结构，在心外膜导管消融时，无论是使用射频还是冷冻能量，都会影响消融损伤的大小。了解每种环境中的差异效应对于指导增加消融损伤深度的策略非常重要。在使用主动冷却射频消融时，可以改变局部阻抗以选择性地增加能量传递。
