不同压力情况下盐水灌注导管消融对心耳组织损伤效果的影响

The effect of different contact force during radiofrequency ablation with irrigation on atrial appendage

目的探讨左右心耳盐水灌注导管消融时,不同压力对组织消融损伤程度的影响。方法将6头猪左右心耳组织,置于水浴37℃水浴槽中。根据导管压力分为A组(5 g)、B组(15 g)和C组(20 g)。消融功率、灌注速度和温度分别设置为:30 W、17 ml/min和43℃。每个心耳消融4次,共计消融48次,每组消融16次。实验中测量组织厚度;记录消融开始、结束阻抗;最大功率;最大温度;组织表面最大损伤宽度与长度;是否达到透壁损伤;是否发生pop等参数。结果消融最大损伤宽度B组显著高于A组(P=0.05);C组与A组相比,差异更大(P=0.01),C组较B组有增加趋势,但无显著差异(P>0.05)。消融最大损伤长度、最大损伤面积随着压力增加而增加,但在三组之间无显著差异(P均>0.05)。透壁性损伤在A、B、C三组分别为75.0%,93.8%,100.0%(P=0.02)。Pop发生率在A、B、C三组分别为25.0%,31.3%和43.8%(P=0.52)。消融开始时阻抗、最大阻抗与最小阻抗随着消融导管与组织之间压力增加而增加。B组较A组相比,有显著差异(P=0.001),C组较A组相比,差异更大(P=0.000),但C组较B组相比,无显著差异(P>0.05)。结论心耳组织消融时,压力、功率、灌注速度分别设置为15 g、30 W和17 ml/min可以获得较高的透壁性与较低pop发生率。

Objective To investigate the effect of different contact force on the tissue ablation injury with irrigated catheter ablation for left and right appendages.Methods The left and right atrial appendage tissues were placed in a water bath at 37°C.According to the catheter contact force,the experiment was diveded into three groups:group A(5 g),group B(15 g)and group C(20 g).The ablation power,irrigation flow and temperature were set at 30 W,17 ml/min and 43°C,respectively.In the experiment,tissue thickness was measured;the impedance of ablation beginning and ending was recorded;the maximum power;the maximum temperature;the maximum injury width and length of tissue surface;whether the transmural injury was achieved;whether pop occurred.Results In this study,16 ablations were performed in each group.The maximum injury width in group B was significantly different from that in group A(P=0.05).The difference between group C and group A was greater(P=0.01).There was no significant difference between group C and group B(P>0.05).There was no significant difference in the maximum injury length and area between the three groups(P>0.05).The transmural injuries were 75.0%,93.8%,100.0%from group A to group C(P=0.02),respectively.The incidence of pop was 25.0%,31.3%and 43.8%in the three groups(P=0.52),respectively.The impedance at the beginning of ablation,maximum impedance and minimum impedance increased with the increase of contact force.There was a significant difference between group B and group A(P=0.001)and group C had a greater difference than group A(P=0.000),but there was no significant difference between group C and group B(P>0.05).Conclusions When the contact force,power and irrigation speed were set to 15 g,30 Wand 17 ml/min respectively,the higher transmural permeability and lower incidence of pop could be obtained.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(6):562-565]