Department of Cardiology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, 1397-1, Japan.
Department of Medical Engineer, Saitama Medical University International Medical Center, Hidaka, Japan.
J Interv Card Electrophysiol. 2024 Jan;67(1):147-155. doi: 10.1007/s10840-023-01583-z. Epub 2023 Jun 13.
The lesion index (LSI) helps predict the lesion size and is widely used in ablation of various types of arrhythmias. However, the influence of the ablation settings on the lesion formation and incidence of steam pops under the same LSI value remains unclear.
Using a contact force (CF) sensing catheter (TactiCath™) in an ex vivo swine left ventricle model, RF lesions were created with a combination of various power steps (30 W, 40 W, 50 W) and CFs (10 g, 20 g, 30 g, 40 g, 50 g) under the same LSI values (5.2 and 7.0). The correlation between the lesion formation and ablation parameters was evaluated.
Ninety RF lesions were created under a target LSI value of 5.2, and eighty-four were developed under a target LSI value of 7.0. In the LSI 5.2 group, the resultant lesion size widely varied according to the ablation power, and a multiple regression analysis indicated that the ablation energy delivered was the best predictor of the lesion formation. To create a lesion depth > 4 mm, an ablation energy of 393 J is the best cutoff value, suggesting a possibility that ablation energy may be used as a supplemental marker that better monitors the progress of the lesion formation in an LSI 5.2 ablation. In contrast, such inconsistency was not obvious in the LSI 7.0 group. Compared with 30 W, the 50-W ablation exhibited a higher incidence of steam pops in both the LSI 5.2 and 7.0 groups.
The LSI-lesion size relationship was not necessarily consistent, especially for an LSI of 5.2. To avoid any unintentional, weak ablation, the ablation energy may be a useful supportive parameter (393 J as a cutoff value for a 4-mm depth) during ablation with an LSI around 5.2. Thanks to a prolonged ablation time, the LSI-lesion size relationship is consistent for an LSI of 7.0. However, it is accompanied by a high incidence of steam pops. Care should be given to the ablation settings even when the same LSI value is used.
病变指数（LSI）有助于预测病变大小，广泛应用于各种类型心律失常的消融治疗。然而，在相同 LSI 值下，消融参数对病变形成和蒸汽 pops 发生率的影响尚不清楚。
使用接触力（CF）感应导管（TactiCath™）在离体猪左心室模型中，在相同 LSI 值（5.2 和 7.0）下，使用不同功率（30 W、40 W、50 W）和 CF（10 g、20 g、30 g、40 g、50 g）组合创建 RF 消融灶。评估病变形成与消融参数之间的相关性。
在目标 LSI 值为 5.2 时创建了 90 个 RF 消融灶，在目标 LSI 值为 7.0 时创建了 84 个。在 LSI 5.2 组中，根据消融功率，得到的病变大小差异很大，多元回归分析表明，消融能量是病变形成的最佳预测因子。为了形成深度大于 4mm 的病变，393J 的消融能量是最佳截断值，这表明消融能量可能作为补充标志物，更好地监测 LSI 5.2 消融过程中的病变形成进展。相比之下，LSI 7.0 组中没有明显的不一致性。与 30 W 相比，50 W 消融在 LSI 5.2 和 7.0 组中蒸汽 pops 的发生率更高。
LSI-病变大小关系不一定一致，尤其是对于 LSI 5.2。为避免任何非故意的、弱消融，在 LSI 5.2 左右消融时，消融能量（4mm 深度的 393J 作为截断值）可能是一个有用的辅助参数。由于消融时间延长，LSI 7.0 的 LSI-病变大小关系一致。然而，随之而来的是蒸汽 pops 发生率较高。即使使用相同的 LSI 值，也应注意消融参数的设置。
