Derejko Paweł, Janus Izabela, Kułakowski Piotr, Kuśnierz Jacek, Baran Jakub, Hangiel Urszula, Proszek Joanna, Frydrychowski Piotr, Michałek Marcin, Noszczyk-Nowak Agnieszka
Department of Cardiology, Medicover Hospital, Warsaw, Poland; Department of Cardiac Arrhythmias, National Institute of Cardiology, Warsaw, Poland.
Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland.
Heart Rhythm. 2024 Jun;21(6):790-798. doi: 10.1016/j.hrthm.2024.02.009. Epub 2024 Feb 8.
Bipolar radiofrequency ablation (B-RFA) is a method used to treat the arrhythmia substrate resistant to unipolar ablation. Few studies have addressed endo-epicardial B-RFA.
The aim of the study was to evaluate chronic lesions resulting from endo-epicardial B-RFA and to determine optimal settings for such procedures in an animal model.
In 7 pigs, up to 5 radiofrequency applications per animal were performed with 2 electrodes placed on both sides of the left ventricular free wall. Current was delivered for 60 seconds by a generator dedicated for B-RFA with power settings of 25, 30, 35, 40, and 50 W.
At 12 weeks after ablation, 31 lesions were assessed. Their maximal cross-sectional area ranged from 7.2 to 68 mm and correlated with total power delivered (r = 0.53), with temperature increment at the endocardial catheter (r = 0.65), and inversely with temperature decrement at the epicardial catheter (r = 0.54). For power values between 30 and 40 W, the lesion area did not differ significantly (P = .92). Lesion depth ranged from 1.9 to 11 mm and correlated with impedance decrement (r = 0.5). Lesions were transmural in 8 cases. Lesion depth/wall thickness ratio was on average 0.6 ± 0.3, with the smallest value for 25 W (0.5 ± 0.3) and the largest for 50 W (0.8 ± 0.3). Steam pops occurred at a power range of 30-50 W, with an incidence of 1 in 5 applications, with 1 case of fatal tamponade at 40 W. Impedance decrement, endocardial catheter temperature increment, and endocardial electrogram amplitude decrement were greater during applications with steam pops.
Chronic lesions resulting from endo-epicardial B-RFA appear smaller and less often transmural compared with acute lesions described in the literature. The incidence of steam pops during endo-epicardial B-RFA is relatively high even at low powers.
双极射频消融术（B-RFA）是一种用于治疗对单极消融有抵抗的心律失常基质的方法。很少有研究涉及心内膜-心外膜B-RFA。
本研究的目的是评估心内膜-心外膜B-RFA产生的慢性损伤，并在动物模型中确定此类手术的最佳设置。
对7头猪进行实验，每头猪在左心室游离壁两侧放置2个电极，最多进行5次射频应用。通过专门用于B-RFA的发生器输送电流60秒，功率设置为25、30、35、40和50W。
消融后12周，评估了31个损伤。其最大横截面积范围为7.2至68mm，与输送的总功率相关（r = 0.53），与心内膜导管处的温度升高相关（r = 0.65），与心外膜导管处的温度降低呈负相关（r = 0.54）。对于30至40W的功率值，损伤面积无显著差异（P = 0.92）。损伤深度范围为1.9至11mm，与阻抗降低相关（r = 0.5）。8例损伤为透壁性。损伤深度/壁厚比平均为0.6±0.3，25W时最小（0.5±0.3），50W时最大（0.8±0.3）。在30-50W的功率范围内出现蒸汽爆发现象，每5次应用中有1次发生，40W时发生1例致命性心包填塞。出现蒸汽爆发时，阻抗降低、心内膜导管温度升高和心内膜电图幅度降低更为明显。
与文献中描述的急性损伤相比，心内膜-心外膜B-RFA产生的慢性损伤似乎更小，透壁性损伤更少。即使在低功率下心内膜-心外膜B-RFA期间蒸汽爆发的发生率也相对较高。
