通过动物实验评价射频能量对冠状动脉的急性损伤

Acute pathological change of coronary artery after radiofrequency current application in animal experiment

目的通过动物实验观察射频消融术(RFCA)是否会导致冠状动脉(简称冠脉)的急性损伤,对比不同的消融方法对冠脉的影响。方法取成年犬21只,雌雄不限,随机分三组,第一组消融电极为4mm,能量级别设定为60℃/120s,分别消融左房室环、右房室环、冠状静脉窦内和心外膜的近冠脉处;第二组能量级别设定为80℃/120s,分别消融除心外膜外的其它三处;第三组消融电极为8mm,能量级别设定为60℃/120s,仅消融左右房室环。术毕观察消融点附近冠脉损伤情况,并取消融点及附近冠脉作病理检查,光镜下观察心肌和冠脉的变化。结果大体下观察,没有发现冠脉管腔的狭窄及管腔内血栓形成。对63处消融点附近的冠脉进行光镜检查时,3例冠脉或其分支出现明显变化,动脉壁破裂、壁结构消失、平滑肌溃疡、变性坏死,溃疡内有大量白细胞浸润;9例冠脉内皮细胞出现肿胀、脱落甚至消失;其余冠脉未有任何变化。结论常规RFCA是安全可靠的,但特殊部位、高能量射频消融时,应注意冠脉的损伤。

Objective To observe coronary artery acute pathological changes after radiofrequency catheter ablation（ RF- CA） by animal experiment, and compare the coronary artery changes resulted from different radiofrequency ablation methods. Methods Twenty-one health miscellaneous dogs （both male and female） were divided into 3 groups randomly. The radiofrequency current was delivered by 4 mm electrode at 60℃ for 120 in first groups. The second group was delivered current at 80℃ for 120 s by using 4 mm electrode. For third group,current was at 60℃ for 120 s with 8 mm electrode. The first group had four ablation sites which was left atrioventicular ring, right atrioventicular ring, coronary vein and epicardiurn. The second group had the three ablation sites except for epicardium. The third group was only ablated left and right atrioventicular ring. When RFCA was over, all lesions with the adjacent coronary artery were removed and processed in microseries. Result Among 63 sites, coronary arteries at 3 sites ruptured, constitution of coronary artery wall disappeared, smooth muscle occurrenced anabrosis leucocyte infiltration, degeneration, necrosis. 9 sites presented stripping, swelling and vanishment of coronary endothelium. The rest had no changes. Condusions Routine radiofrequency ablation is safe. But coronary artery lesion should be paid more attention when catheter ablation is at special location and with high energy.