Piccini Jonathan P, Dave Amish S, Holmes Douglas S, Winterfield Jeffrey R, Tranter John H, Pipenhagen Catherine, Moon L Boyce, Ambrosius Nicholas M, Overmann Jed A, Boudlali Hana, Thao Riki, Geurkink Chris, Thamavong Zada, Jensen James A, Fish Jeffrey M
Electrophysiology Section, Duke University Hospital, Durham, North Carolina.
Houston Methodist DeBakey Cardiology Associates, Houston, Texas.
Heart Rhythm O2. 2023 Jun 10;4(7):440-447. doi: 10.1016/j.hroo.2023.06.005. eCollection 2023 Jul.
High-power, short-duration (HPSD) radiofrequency ablation (RFA) reduces procedure time; however, safety and efficacy thresholds vary with catheter design.
The study sought to determine optimal HPSD ablation conditions with a novel flexible-tipped, contact force-sensing RFA catheter.
RFA lesions were created in thigh muscle (16 swine) over a range of conditions (51-82 W, 2-40 g, 8-40 mL/min irrigation). An intracardiac study was performed (12 swine) to characterize steam pop thresholds. Lesions were created in a second intracardiac study (14 swine, n = 290 pulmonary vein isolation [PVI] lesions) with combinations of radiofrequency power, duration, and contact force. PVI was tested, animals were sacrificed, and lesions were measured.
The likelihood of coagulation formation in the thigh model was <20% when power was ≤79 W, when contact force was ≤40 g, when duration was ≤11 seconds, and when irrigation rates were 8 to 40 mL/min. The impact of contact force on lesion safety and efficacy was more pronounced using HPSD (60 W/8 seconds) compared with conventional ablation (30 W/45 seconds) ( = .038). During PVI, focal atrial lesions ranged in width from 4.2 to 12.5 mm and were transmural 80.8% of the time. PVI was achieved in 13 of 14 veins. Logistic regression identified that the optimal parameters for radiofrequency application were 60 to 70 W with a duration <8 seconds and <15 g contact force.
Optimal HPSD lesions with this this flexible-tipped, force-sensing RFA catheter were created at 60 to 70 W for <8 seconds with <15 g contact force. Chronic studies are ongoing to assess radiofrequency parameter refinements and long-term lesion durability using these conditions.
高功率、短持续时间（HPSD）射频消融（RFA）可缩短手术时间；然而，安全和疗效阈值会因导管设计而异。
本研究旨在使用新型柔性尖端、接触力传感RFA导管确定最佳HPSD消融条件。
在一系列条件（51 - 82瓦、2 - 40克、8 - 40毫升/分钟冲洗）下，在大腿肌肉中（16头猪）创建RFA损伤。进行了一项心内研究（12头猪）以确定蒸汽泡阈值特征。在第二项心内研究中（14头猪，n = 290个肺静脉隔离[PVI]损伤），通过射频功率、持续时间和接触力的组合创建损伤。对PVI进行测试，处死动物并测量损伤。
当功率≤79瓦、接触力≤40克、持续时间≤11秒且冲洗速率为8至40毫升/分钟时，大腿模型中形成凝血的可能性<20%。与传统消融（30瓦/45秒）相比，使用HPSD（60瓦/8秒）时接触力对损伤安全性和疗效的影响更为显著（P = 0.038）。在PVI期间，局灶性心房损伤宽度为4.2至12.5毫米，80.8%的时间为透壁性。14条静脉中有13条实现了PVI。逻辑回归确定，射频应用的最佳参数为60至70瓦，持续时间<8秒且接触力<15克。
使用这种柔性尖端、力传感RFA导管，在60至70瓦、<8秒、<15克接触力的条件下可创建最佳HPSD损伤。正在进行长期研究以评估使用这些条件对射频参数的优化以及长期损伤耐久性。
