QDOT MICRO^(TM)导管两种模式与传统导管功率控制模式对消融损伤灶影响的对比研究

Comparison of lesion geometry for radiofrequency ablation with the two modes of QDOT MICRO^(TM)catheter and conventional power controlled mode

目的探讨QDOT MICRO^(TM)(QDOT)导管两种模式消融效果的安全性,以及与传统导管功率控制(PC)模式相比不同参数设置对消融创痕的影响。方法应用新鲜离体猪心,比较QDOT导管的温度/流速控制(TFC)模式与THERMOCOOL SMARTTOUCHTM SF(STSF)导管的PC模式在不同消融指数(AI,400、500)分组下的创痕大小和安全性。同时评估QDOT导管的超高功率短时程消融模式(vHPSD)和TFC模式在不同接触压力(5、15和30 g)和不同贴靠角度(0°、45°和90°)分组下的创痕大小和安全性,并对比两种模式在不同消融间距(4 mm和6 mm)分组下创痕的均匀性、连续性和安全性。结果在AI相同时,TFC与PC模式所产生的创痕的深度、表面宽度、最大横径以及体积的差异均无统计学意义(均为P>0.05)。与目标AI为400时TFC模式相比,vHPSD模式所产生创痕的表面宽度和最大横径的差异均无统计学意义(均为P>0.05),但vHPSD模式产生的创痕更浅[(1.95±0.38)mm比(2.72±0.31)mm,P<0.001]、体积更小[(30.35±11.34)mm^(3)比(48.78±19.82)mm^(3),P=0.040]。接触压力对创痕情况影响不显著,各参数差异均无统计学意义(均为P>0.05)。各组创痕表面宽度均在贴靠角度90°时最小,且在目标AI为500的TFC模式组不同贴靠角度导致的创痕表面宽度差异有统计学意义(P=0.027)。此外,消融间距为4 mm时,vHPSD模式和TFC模式均能产生均匀且连续的线状创痕;消融间距为6 mm时,vHPSD模式和目标AI为400的TFC模式组所产生的创痕均不连续,而目标AI为500的TFC模式组产生的创痕具有良好的连续性。应用QDOT导管和STSF导管消融均未产生气爆和焦痂。结论在AI相同时,QDOT导管的TFC模式与STSF导管的PC模式消融效果相似。与TFC模式相比,vHPSD模式产生的创痕深度更浅,体积更小。QDOT导管的TFC模式和vHPSD模式安全性均较高。

Objective To investigate the safety of the novel QDOT MICRO^(TM)catheter(QDOT)in two operational modes and the impact of different parameters on its ablation outcomes in comparison with the power controlled mode(PC).Methods This ex vivo study was carried out on swine hearts.Lesions created by the temperature/flow controlled mode(TFC)of the QDOT catheter and the PC of the THERMOCOOL SMARTTOUCHTM SF catheter(STSF)were compared under various ablation index(AI,400 and 500).Additionally,lesions created by the very high-power short-duration mode(vHPSD)of the QDOT catheter were compared with the TFC mode under various contact force(5,15 and 30 g)and angles(0°,45°and 90°).The homogeneity and continuity of the lesions created by both modes at various inter-lesion distance(4 mm and 6 mm)were also evaluated.Finally,the safety of the QDOT catheter was evaluated by the number of steam pops and charring occurred.Results When aiming at the same AI,lesions created by the TFC mode were comparable to those created by the PC Mode,whether in maximum depth,surface diameter,maximum diameter,or lesion volume(all P>0.05).There were no significant differences in surface diameter and maximum diameter of lesions created by the vHPSD mode and the TFC-mode aiming at an AI of 400(both P>0.05).However,the vHPSD mode resulted in shallower lesions(1.95±0.38 mm vs.2.72±0.31 mm,P<0.01)with smaller volumes(30.35±11.34 mm^(3)vs.48.78±19.82 mm^(3),P=0.040).The effect of contact force was not significant,as there were no significant differences in any parameter(all P>0.05).The surface diameter was smallest when the contact angle was 90°,and there was significant difference when using the TFC mode aiming at an AI of 500 under various contact angles(P=0.027).Additionally,at an inter-lesion distance of 4 mm,linear lesions created by the vHPSD mode and the TFC mode were homogeneous and contiguous;at an inter-lesion distance of 6 mm,the vHPSD mode,and the TFC mode aiming at an AI of 400 exhibited gaps within the linear lesions,while linear lesions created by the TFC mode aiming at an AI of 500 were more contiguous.No steam pop or charring was observed while using the QDOT and the STSF catheter.Conclusions The efficacy and safety of TFC mode of the novel QDOT catheter are comparable to PC mode of the STSF catheter.vHPSD mode creates wide but shallow lesions.Both the vHPSD mode and the TFC mode of the QDOT catheter demonstrated a high level of safety.