Willems S, Chen X, Kottkamp H, Hindricks G, Haverkamp W, Rotman B, Shenasa M, Breithardt G, Borggrefe M
Department of Cardiology and Angiology, Hospital of the Westfälische Wilhelms University of Münster, Germany.
Eur Heart J. 1996 Mar;17(3):445-52. doi: 10.1093/oxfordjournals.eurheartj.a014878.
The primary objectives of this study were to assess the feasibility of temperature-controlled radiofrequency catheter ablation of left and right sided manifest accessory pathways in patients with Wolff-Parkinson-White syndrome and to gain more insights into biophysical aspects of temperature-controlled catheter ablation in humans.
The electrode-tissue interface temperature and other biophysical parameters are among important variables determining the efficacy and safety of radiofrequency ablation of accessory pathways. Experimental studies have shown that radiofrequency-induced tissue necrosis can be accurately predicted by monitoring of catheter tip temperature.
38 consecutive patients (14 f, 24 m; aged 42 +/- 12 years) with anterograde conducting accessory pathways (left sided: n = 22; right sided: n = 16) underwent temperature-controlled radiofrequency ablation (HAT 200S, Dr Osypka, Germany). The electrode temperature was monitored via a thermistor embedded into a 4 mm catheter tip. Power output was adjusted automatically during energy delivery in a closed loop system (preselected temp.: 70.1 +/- 5.8 degrees C).
Accessory pathway conduction was successfully abolished in all patients after the delivery of 2.3 +/- 2.1 radiofrequency pulses (range: 1-9, median: 2). Interruption of the accessory pathway as evidenced by loss of preexcitation occurred after 5.9 +/- 5.4 s. At the time of the interruption of the accessory pathway the catheter tip temperature measured 54.2 +/- 11.2 degrees C in patients with left and 44.9 +/- 5.0 degrees C in patients with right sided accessory pathways, respectively (P < 0.008). Higher temperature levels during left sided applications did not shorten the time it took for the effect to appear (left sided accessory pathway: 7.5 +/- 6.3 s, right sided accessory pathway: 3.7 +/- 2.9 s; ns). The catheter tip temperature was significantly higher during left compared to right sided applications after 5 (52.1 +/- 3.1 degrees C vs 47.2 +/- 4.3 degrees C) and 10 s (61.5 +/- 6.2 degrees C vs 52.7 +/- 4.2 degrees C) following initiation of the impulse (P < 0.005). Power output and delivered energy did not differ significantly at the time of accessory pathway abolition. Peak values of delivered power (45.1 +/- 10.9 W vs 41.3 +/- 10.6 W; P < 0.05) and total delivered energy (2452 +/- 1335 J vs 1392 +/- 762 J; P < 0.02) were significantly higher in the group of right sided pathways compared to left sided applications. The peak temperature measured 77.1 +/- 13 degrees C during effective and 69.9 +/- 14 degrees C during ineffective energy applications (P < 0.05). The time it took for the effect to appear was significantly longer in transiently effective pulses (10.4 +/- 7.2 s) compared to permanently effective applications (5.9 +/- 5.4 s; P < 0.02). Despite temperature control, an abrupt rise in impedance was observed in 10 of 89 (11%) energy applications. No procedure-related complications occurred.
Temperature-controlled radiofrequency ablation of manifest accessory pathways is highly effective and safe. The temperature response is faster and significantly higher in left-sided energy applications compared to right-sided pulses. Peak temperature levels measured at the electrode tip are significantly higher during effective than ineffective pulses. Sudden rises in impedance are not completely prevented during temperature-controlled radiofrequency ablation of accessory pathway, although no procedure-related complications were noted in this patient cohort.
本研究的主要目的是评估温控射频导管消融治疗预激综合征患者左侧和右侧显性旁路的可行性，并深入了解人体温控导管消融的生物物理方面。
电极-组织界面温度和其他生物物理参数是决定射频消融旁路疗效和安全性的重要变量。实验研究表明，通过监测导管尖端温度可以准确预测射频诱导的组织坏死。
38例连续性患者（14例女性，24例男性；年龄42±12岁），有顺行传导的旁路（左侧：n = 22；右侧：n = 16），接受了温控射频消融（HAT 200S，德国Osypka博士公司）。通过嵌入4毫米导管尖端的热敏电阻监测电极温度。在闭环系统中能量输送期间自动调整功率输出（预选温度：70.1±5.8℃）。
在输送2.3±2.1次射频脉冲（范围：1 - 9，中位数：2）后，所有患者的旁路传导均成功消除。预激消失证明旁路中断发生在5.9±5.4秒后。在旁路中断时，左侧旁路患者的导管尖端温度为54.2±11.2℃，右侧旁路患者为44.9±5.0℃（P < 0.008）。左侧应用期间较高的温度水平并未缩短效果出现所需的时间（左侧旁路：7.5±6.3秒，右侧旁路：3.7±2.9秒；无显著性差异）。在冲动开始后5秒（52.1±3.1℃对47.2±4.3℃）和10秒（61.5±6.2℃对52.7±4.2℃）时，左侧应用时的导管尖端温度明显高于右侧应用（P < 0.005）。在旁路消除时，功率输出和输送能量无显著差异。右侧旁路组的输送功率峰值（45.1±10.9瓦对41.3±10.6瓦；P < 0.05）和总输送能量（2452±1335焦耳对1392±762焦耳；P < 0.02）明显高于左侧应用。有效能量应用期间测量的峰值温度为77.1±13℃，无效能量应用期间为69.9±14℃（P < 0.05）。与永久有效应用（5.9±5.4秒）相比，短暂有效脉冲中效果出现所需的时间明显更长（10.4±7.2秒）（P < 0.02）。尽管进行了温度控制，但在89次能量应用中有10次（11%）观察到阻抗突然升高。未发生与手术相关的并发症。
温控射频消融显性旁路高效且安全。与右侧脉冲相比，左侧能量应用中的温度反应更快且明显更高。有效脉冲期间电极尖端测量的峰值温度明显高于无效脉冲。在温控射频消融旁路期间，尽管该患者队列中未观察到与手术相关的并发症，但阻抗突然升高并未完全避免。
