Calkins H, Prystowsky E, Carlson M, Klein L S, Saul J P, Gillette P
Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Circulation. 1994 Sep;90(3):1279-86. doi: 10.1161/01.cir.90.3.1279.
The purpose of this study was to evaluate electrode temperatures obtained using a radiofrequency ablation system that incorporates closed loop feedback control to achieve preset target electrode temperatures and to determine if closed loop temperature control results in a lower incidence of developing a coagulum.
Two hundred seventy patients underwent catheter ablation of atrioventricular nodal reentrant tachycardia, an accessory pathway, and/or the atrioventricular junction using an ablation system incorporating closed loop feedback control. Forty-five patients underwent catheter ablation in the power control mode in which power output was fixed, and 225 patients underwent catheter ablation in the temperature control mode. A coagulum occurred during 0.8% of radiofrequency applications in the temperature control mode versus 2.2% in the power control mode (P < .01). Electrode temperatures were within 10 degrees C of the targeted temperature during 35% of applications in the temperature control mode. Ability to achieve the targeted electrode temperature was related to the target, with radiofrequency energy applications at the atrioventricular junction resulting in the highest temperatures (70 +/- 12 degrees C) and those for ablation of the atrioventricular node the lowest (59 +/- 11 degrees C, P < .001), using a maximum of 50 W of power for both. Electrode temperatures were higher during ablation of left free wall and posteroseptal pathways than during ablation of right free wall and septal pathways. The mean and minimum temperatures associated with success were 64 +/- 12 degrees C and 44 degrees C, respectively. Overall, the electrode temperatures at successful and unsuccessful ablation sites did not differ (P > .05).
Temperature monitoring with closed loop control of power output facilitates radiofrequency catheter ablation procedures by minimizing the probability of developing a coagulum while ensuring maximum lesion formation.
本研究的目的是评估使用结合闭环反馈控制以达到预设目标电极温度的射频消融系统所获得的电极温度，并确定闭环温度控制是否会降低形成凝块的发生率。
270例患者使用结合闭环反馈控制的消融系统进行房室结折返性心动过速、旁路和/或房室交界区的导管消融。45例患者在功率控制模式下进行导管消融，其中功率输出固定，225例患者在温度控制模式下进行导管消融。在温度控制模式下，0.8%的射频应用过程中出现凝块，而在功率控制模式下为2.2%（P <.01）。在温度控制模式下，35%的应用过程中电极温度在目标温度的10摄氏度范围内。达到目标电极温度的能力与目标有关，使用最大功率50W时，房室交界区的射频能量应用导致最高温度（70±12摄氏度），而房室结消融的温度最低（59±11摄氏度，P <.001）。左游离壁和后间隔旁路消融期间的电极温度高于右游离壁和间隔旁路消融期间的温度。成功消融相关的平均温度和最低温度分别为64±12摄氏度和44摄氏度。总体而言，成功和未成功消融部位的电极温度无差异（P>.05）。
通过对功率输出进行闭环控制的温度监测，有助于射频导管消融手术，可在确保最大损伤形成的同时，将形成凝块的概率降至最低。
