Avitall B, Hare J, Krum D, Dhala A
Electrophysiology Research Laboratory, University of Wisconsin-Milwaukee Clinical Campus, Sinai Samaritan Medical Center 53201.
Pacing Clin Electrophysiol. 1994 May;17(5 Pt 1):908-18. doi: 10.1111/j.1540-8159.1994.tb01432.x.
An important factor in the efficient and successful completion of the ablation procedure is the design characteristics of the mapping/ablation catheters. These procedures are often hampered by the inability to maneuver the catheter to the desired location, in part because the catheters only have a single plane deflection capability and are not designed for the specific cardiac anatomical structures that contain the arrhythmogenic substrate. Single and Biplane Deflectable Catheters: Using measurements taken from six normal human cadaver hearts, ablation catheter design characteristics are presented for posterior, posterior septal, lateral, and posterior lateral pathways for retrograde and transseptal approaches. Three catheter designs based on anatomical characteristics were also evaluated. Pigtail Catheter: This catheter adapts to the atrial side of the mitral ring and improves positioning and stability for mapping and ablation of left-sided accessory pathways. Loop Catheter: This catheter is positioned at the perivalvular tricuspid ring and provides simultaneous mapping and ablation capabilities without the need to move the catheter or the need for additional catheters. Rotating Tip Catheter: The tip of this catheter is made up of three elongated teeth, which were curved 120 degrees apart into the rotating tip electrode. This electrode was designed to negotiate the surfaces of the atrial and intraventricular chambers. It is capable of discrete movements and has a large electrode-tissue contact area for the ablation of atrial and ventricular arrhythmias. Catheter designs presented in this article are based on the ability of the catheter to adapt to the anatomical location of the arrhythmogenic tissue as well as the maneuverability of the catheter's mapping and ablation electrodes. An anatomical approach to the design of ablation catheter technology is likely to reduce the x-ray radiation exposure for patient and operator, and may further increase the success rate of the procedure.
消融手术高效且成功完成的一个重要因素是标测/消融导管的设计特点。这些手术常常因无法将导管操控到理想位置而受阻，部分原因是导管仅具有单平面偏转能力，且并非针对包含致心律失常基质的特定心脏解剖结构设计。单平面和双平面可偏转导管：利用从六个正常人体尸体心脏获取的测量数据，展示了用于逆行和经间隔途径的后、后间隔、外侧和后外侧径路的消融导管设计特点。还评估了基于解剖学特征的三种导管设计。猪尾导管：这种导管可适应二尖瓣环的心房侧，改善左侧旁路标测和消融的定位及稳定性。环导管：该导管置于三尖瓣环周，无需移动导管或使用额外导管即可同时进行标测和消融。旋转头导管：此导管的头部由三个细长齿组成，它们相隔120度弯曲形成旋转头电极。该电极设计用于在心房和心室内腔表面操作。它能够进行离散运动，且具有较大的电极 - 组织接触面积，用于消融心房和心室心律失常。本文介绍的导管设计基于导管适应致心律失常组织解剖位置的能力以及导管标测和消融电极的可操作性。采用解剖学方法设计消融导管技术可能会减少患者和操作者的X射线辐射暴露，并可能进一步提高手术成功率。
