Watanabe I, Nakai T, Yanagawa S, Watanabe H, Kojima T, Kondo K, Takahashi Y, Saito S, Ozawa Y, Kanmatsuse K
Second Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Jpn Heart J. 1997 Jan;38(1):107-15. doi: 10.1536/ihj.38.107.
Arching and barotrauma, seen with high energy DC catheter ablation, are responsible for diffuse cardiac damage and coronary sinus rupture. In six anesthetized dogs, we investigated the effects of an increasing number of short time-constant capacitive shocks on the volume of myocardial damage. Each dog received capacitive shocks of 2 J/kg at 3 sites in the left ventricle. One shock was delivered in 2 dogs, 2 shocks were delivered in 2 dogs and 3 shocks were delivered in 2 dogs. Shock delivery was not accompanied by hemodynamic collapse, sustained ventricular tachycardia or ventricular fibrillation. The dogs were sacrificed at 60 minutes. Mean (SEM) lesion volumes were 195 (39) mm3, 480 (41) mm3, and 595 (110) mm3, respectively. Despite variability in individual volume of damage, there was a significant increase in lesion volume with an increasing number of shocks. There was no evidence of perforation or tamponade. Increasing myocardial damage can be produced using repetitive capacitive shocks. Delivery of 2 shocks produces clinically useful lesions without the adverse effects associated with single high energy shocks. Repetitive capacitive shocks offer a method of increasing lesion volume without increasing energy and thereby without compromising safety.
与高能量直流电导管消融相关的弓状损伤和气压伤，是弥漫性心脏损伤和冠状窦破裂的原因。在6只麻醉犬中，我们研究了短时间常数电容性电击次数增加对心肌损伤体积的影响。每只犬在左心室的3个部位接受2 J/kg的电容性电击。2只犬接受1次电击，2只犬接受2次电击，2只犬接受3次电击。电击过程中未出现血流动力学崩溃、持续性室性心动过速或心室颤动。60分钟后处死这些犬。平均（标准误）损伤体积分别为195（39）mm³、480（41）mm³和595（110）mm³。尽管个体损伤体积存在差异，但随着电击次数增加，损伤体积显著增大。未发现穿孔或心包填塞的证据。使用重复性电容性电击可导致心肌损伤增加。给予2次电击可产生临床上有用的损伤，且无单次高能量电击相关的不良反应。重复性电容性电击提供了一种在不增加能量从而不影响安全性的情况下增加损伤体积的方法。
