Verma Atul, Maffre Jennifer, Sharma Tushar, Farshchi-Heydari Salman
Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (A.V.).
Department of Research and Development, Biosense Webster, Inc, Irvine, CA (J.M., T.S., S.F.-H.).
Circ Arrhythm Electrophysiol. 2025 Feb;18(2):e013143. doi: 10.1161/CIRCEP.124.013143. Epub 2025 Jan 24.
Sequential application of radiofrequency with pulsed field (PF) ablation may increase lesion depth while preserving the advantages of PF. The study's aim was to determine lesion dimensions of sequential, colocalized radiofrequency and PF ablation.
A preclinical study using swine (n=4) performed lesions in the right/left ventricles. Ablations were performed with a force-sensing 3.5-mm irrigated-tip ablation catheter using a generator delivering both radiofrequency and PF. PF was delivered using unipolar, biphasic pulses at a standard dose (PF index, 300) with 4-mL/min irrigation. Radiofrequency was delivered at 50 W for 10 s (15 mL/min). Lesions were created by applying colocalized radiofrequency followed by sequential application of PF on the same location, PF followed by sequential application of radiofrequency on the same location, PF alone, or radiofrequency alone. Tissue was collected after 2 hours for lesion assessment. Results are mean±SD.
Forty-five lesions were analyzed. The lesion depth of radiofrequency alone was 4.9±0.8 mm. The mean lesion depth and width for PF alone were 3.5±0.6 and 5.1±1.8 mm. Lesion depths for combined applications were significantly greater versus PF alone (6.2±1.8 mm radiofrequency followed by sequential application of PF on the same location; 5.7±1.3 mm PF followed by sequential application of radiofrequency on the same location; <0.0001 for both). Lesion widths were also significantly greater with combined therapy versus PF alone (8.6±1.8 mm radiofrequency followed by sequential application of PF on the same location; 8.9±2.1 mm PF followed by sequential application of radiofrequency on the same location; <0.0001 for both). Histology for both combined lesions showed central thermal necrosis surrounded by a hemorrhagic and transitional PF zone.
Combined, colocalized radiofrequency and PF, irrespective of order, show significantly increased lesion size compared with the same dose of PF or radiofrequency alone.
将射频与脉冲场（PF）消融序贯应用可能会增加消融灶深度，同时保留PF的优势。本研究的目的是确定射频与PF联合、共定位消融后的消融灶尺寸。
一项在猪（n = 4）身上进行的临床前研究，在右/左心室制造消融灶。使用配备有能同时输送射频和PF的发生器的3.5毫米压力感应灌注消融导管进行消融。PF采用单极双相脉冲，以标准剂量（PF指数300）、4毫升/分钟的灌注速度输送。射频以50瓦功率输送10秒（15毫升/分钟）。通过在同一位置先进行共定位射频消融，然后序贯应用PF，或先进行PF消融，然后序贯应用射频，或单独应用PF，或单独应用射频来制造消融灶。2小时后收集组织进行消融灶评估。结果以平均值±标准差表示。
共分析了45个消融灶。单独射频消融灶的深度为4.9±0.8毫米。单独PF消融灶的平均深度和宽度分别为3.5±0.6毫米和5.1±1.8毫米。联合应用时的消融灶深度显著大于单独应用PF时（在同一位置先进行射频消融然后序贯应用PF，深度为6.2±1.8毫米；在同一位置先进行PF消融然后序贯应用射频，深度为5.7±1.3毫米；两者均P<0.0001）。联合治疗时的消融灶宽度也显著大于单独应用PF时（在同一位置先进行射频消融然后序贯应用PF，宽度为8.6±1.8毫米；在同一位置先进行PF消融然后序贯应用射频，宽度为8.9±2.1毫米；两者均P<0.0001）。两种联合消融灶的组织学表现均为中央热坏死，周围有出血性和过渡性PF区。
射频与PF联合、共定位应用，无论顺序如何，与相同剂量的单独PF或单独射频相比，消融灶尺寸均显著增大。
