Wen Z C, Chen S A, Chiang C E, Tai C T, Lee S H, Chen Y J, Chiou C W, Ueng K C, Chang M S
Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
Int J Cardiol. 1996 Mar;53(3):279-83. doi: 10.1016/0167-5273(95)02545-6.
Adequate heating with myocardial thermal injury is necessary for successful ablation. This study was designed to examine the relationship between power, temperature, and efficiency of heating during radiofrequency catheter ablation of accessory pathways in 76 patients. During each application of radiofrequency energy, temperature was continually monitored by use of an ablation catheter with a thermistor embedded in the tip of the distal electrode. The efficiency of heating varied by location, with the greatest efficiency of heating for posteroseptal energy applications (2.7 +/- 2.3 degrees C/W), which were significantly greater than for left-sided (2.1 +/- 1.9 degrees C/W, P < 0.01) or right-sided (1.0 +/- 1.1 degrees C/W, P < 0.01) applications. For patients with left free wall and posteroseptal pathways, the temperature, radiofrequency power, time to peak temperature and efficiency of heating were similar between the successful and unsuccessful pulses. However, the mean temperature (53.5 +/- 4.5 vs. 45.1 +/- 5.1 degrees C, P < 0.01) and radiofrequency power (49.6 +/- 5.2 vs. 40.3 +/- 10.2 watt, P < 0.05) differed significantly between the successful and unsuccessful ablation pulses in patients with right free wall pathways. To achieve greater efficiency of heating and higher temperature, it is reasonable to use higher power outputs (40-50 W) in radiofrequency ablation of right free wall pathways, whereas less power outputs (30-40 W) are likely to produce adequate heating of posteroseptal and left free wall pathways, and minimize the risk of impedance rise and coagulum formation.
心肌热损伤的充分加热是成功消融所必需的。本研究旨在探讨76例患者在经导管射频消融旁路时功率、温度和加热效率之间的关系。在每次施加射频能量期间，使用远端电极尖端嵌入热敏电阻的消融导管持续监测温度。加热效率因位置而异，后间隔能量应用的加热效率最高（2.7±2.3℃/W），显著高于左侧（2.1±1.9℃/W，P<0.01）或右侧（1.0±1.1℃/W，P<0.01）应用。对于左游离壁和后间隔旁路的患者，成功和不成功脉冲之间的温度、射频功率、达到峰值温度的时间和加热效率相似。然而，右游离壁旁路患者成功和不成功消融脉冲之间的平均温度（53.5±4.5 vs. 45.1±5.1℃，P<0.01）和射频功率（49.6±5.2 vs. 40.3±10.2瓦，P<0.05）存在显著差异。为了实现更高的加热效率和更高的温度，在右游离壁旁路的射频消融中使用更高的功率输出（40-50W）是合理的，而后间隔和左游离壁旁路可能使用较低的功率输出（30-40W）就足以产生充分的加热，并将阻抗升高和凝块形成的风险降至最低。
