3D Surgical Planning Lab, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain.
BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain.
Int J Hyperthermia. 2021;38(1):582-592. doi: 10.1080/02656736.2021.1909148.
While the standard setting during radiofrequency catheter ablation (RFCA) consists of applying low power for long times, a new setting based on high power and short duration (HPSD) has recently been suggested as safer and more effective. Our aim was to compare the electrical and thermal performance of standard vs. HPSD settings, especially to assess the effect of the catheter orientation.
A 3D computational model was built based on a coupled electric-thermal-flow problem. Standard (20 W-45 s and 30 W-30 s) and HPSD settings (70 W-7 s and 90 W-4 s) were compared. Since the model only included a cardiac tissue fragment, the power values were adjusted to 80% of the clinical values (15, 23, 53 and 69 W). Three catheter-tissue orientations were considered (90°, 45° and 0°). Thermal lesions were assessed by the Arrhenius equation. Safety was assessed by checking the occurrence of steam pops (100 °C in tissue) and thrombus formation (80 °C in blood).
The computed thermal lesions were in close agreement with the experimental data in the literature, in particular with studies. HPSD created shallower and wider lesions than standard settings, especially with the catheter at 45°. Steam pops occurred earlier with HPSD, regardless of catheter orientation.
HPSD seems to be more effective in cases that need shallow and extensive lesions, especially when the catheter is at 0° or at 45°, as used in pulmonary vein isolation.
虽然射频导管消融（RFCA）的标准设置是施加低功率长时间，但最近提出了一种基于高功率和短持续时间（HPSD）的新设置，认为其更安全、更有效。我们的目的是比较标准与 HPSD 设置的电气和热性能，特别是评估导管方向的影响。
基于电-热-流耦合问题建立了一个 3D 计算模型。比较了标准（20 W-45 s 和 30 W-30 s）和 HPSD 设置（70 W-7 s 和 90 W-4 s）。由于模型仅包含心脏组织片段，因此将功率值调整为临床值的 80%（15、23、53 和 69 W）。考虑了三种导管-组织取向（90°、45°和 0°）。通过阿累尼乌斯方程评估热损伤。通过检查蒸汽弹（组织中 100°C）和血栓形成（血液中 80°C）来评估安全性。
计算出的热损伤与文献中的实验数据非常吻合，特别是与[13]研究吻合较好。与标准设置相比，HPSD 产生的损伤更浅、更宽，尤其是在导管为 45°时。无论导管方向如何，HPSD 都会更早地产生蒸汽弹。
HPSD 在需要浅而广泛损伤的情况下似乎更有效，尤其是在导管处于 0°或 45°时，如在肺静脉隔离中使用。
