Department of Cardiovascular Medicine, Tokyo Medical and Dental University.
Department of Cardiovascular Medicine, Akita University Graduate School of Medicine.
Circ J. 2023 Nov 24;87(12):1757-1764. doi: 10.1253/circj.CJ-23-0574. Epub 2023 Oct 27.
For lesion size prediction, each input parameter, including ablation energy (AE), and output parameter, such as impedance, is individually used. We hypothesize that using both parameters simultaneously may be more optimal.
Radiofrequency applications at a range of power (30-50 W), contact force (10 g and 20 g), duration (10-60 s), and catheter orientation with normal saline (NS)- or half-normal saline (HNS)-irrigation were performed in excised porcine hearts. The correlations, with lesion size of AE, absolute impedance drop (∆Imp-drop), relative impedance drop (%Imp-drop), and AE*%Imp-drop were examined. Lesion size was analyzed in 283 of 288 lesions (NS-irrigation, n=142; HNS-irrigation, n=141) without steam pops. AE*%Imp-drop consistently showed the strongest correlations with lesion maximum depth (NS-irrigation, ρ=0.91; HNS-irrigation, ρ=0.94), surface area (NS-irrigation, ρ=0.87; HNS-irrigation, ρ=0.86), and volume (NS-irrigation, ρ=0.94; HNS-irrigation, ρ=0.94) compared with the other parameters. Moreover, compared with AE alone, AE*%Imp-drop significantly improved the strength of correlation with lesion maximum depth (AE vs. AE*%Imp-drop, ρ=0.83 vs. 0.91, P<0.01), surface area (ρ=0.73 vs. 0.87, P<0.01), and volume (ρ=0.84 vs. 0.94, P<0.01) with NS-irrigation. This tendency was also observed with HNS-irrigation. Parallel catheter orientation showed a better correlation with lesion depth and volume using ∆Imp-drop, %Imp-drop, and AE*%Imp-drop than perpendicular orientation.
The combination of input and output parameters is more optimal than each single parameter for lesion prediction.
对于病灶大小预测，每个输入参数（如消融能量[AE]）和输出参数（如阻抗）都单独使用。我们假设同时使用这两个参数可能更优。
在离体猪心模型中，使用射频能量在 30-50W 功率、10g 和 20g 接触力、10-60s 作用时间下，以生理盐水（NS）或半生理盐水（HNS）灌流导管进行不同角度（平行或垂直）的射频消融。评估 AE 与绝对阻抗降低（∆Imp-drop）、相对阻抗降低（%Imp-drop）和 AE*%Imp-drop 与病灶大小的相关性。在 288 个病灶（NS 组 142 个，HNS 组 141 个）中，未发生蒸汽爆破的病灶进行了分析。AE*%Imp-drop 与病灶最大深度（NS 组 ρ=0.91，HNS 组 ρ=0.94）、表面积（NS 组 ρ=0.87，HNS 组 ρ=0.86）和体积（NS 组 ρ=0.94，HNS 组 ρ=0.94）的相关性均最强。与其他参数相比，AE*%Imp-drop 与病灶最大深度（AE 与 AE*%Imp-drop，ρ=0.83 与 0.91，P<0.01）、表面积（ρ=0.73 与 0.87，P<0.01）和体积（ρ=0.84 与 0.94，P<0.01）的相关性也显著提高。在 NS 组中，这种趋势在 HNS 组中也存在。与垂直角度相比，平行角度的导管与病灶深度和体积的相关性更好，使用 ∆Imp-drop、%Imp-drop 和 AE*%Imp-drop 时都如此。
与单独使用每个参数相比，输入和输出参数的组合更有利于病灶预测。
