Ramkumar V Venkateswaran, Shohei Kataoka, Chang Hee Kwon, Sung Ho Lee, Edward P Gerstenfeld
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Two DPs were attached, and the ground was randomly chosen so that one-half of the lesions were concordant (eg, anterior RF/anterior DP) and one-half were discordant (eg, anterior RF/posterior DP). Ablation parameters otherwise remained constant.</p><p><strong>Results: </strong>A total of 77 lesions (38 concordant, 39 discordant) in 10 swine were analyzed. Contact force (18.0 ± 3.2 g vs 17.6 ± 3.5 g; P = 0.606) and baseline impedance (111.3 ± 7.5 Ω vs 110.9 ± 7.3 Ω; P = 0.782) were similar between groups. Lesions with concordant compared with discordant DP had greater lesion depth (7.4 ± 1.8 vs 6.1 ± 1.6 mm; P = 0.001) and area (72.5 ± 22.2 mm<sup>2</sup> vs 59.6 ± 17.5 mm<sup>2</sup>; P = 0.006).</p><p><strong>Conclusions: </strong>Placing the DP on the body surface concordant with the direction of RF ablation results in ∼20% increase in lesion depth. This simple modification can be used to enhance RF lesion size.</p>","PeriodicalId":14573,"journal":{"name":"JACC. 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引用次数: 0
摘要
背景：使用射频（RF）能量消融室性心动过速对于深部电路来说是具有挑战性的。标准射频消融是单极的，能量在导管和色散贴片（DP）之间传递。将DP与射频应用方向对齐可能会改变射频场，从而产生更深的病变。目的：作者试图比较一致性（贴片朝向消融方向）和不一致性DP放置的猪左心室损伤大小。方法：采用冲洗式接触式力传感射频导管对猪左前后心室进行病灶穿刺。连接两个DP，并随机选择地面，以便一半的病变是一致的（例如，前RF/前DP），一半是不一致的（例如，前RF/后DP）。烧蚀参数保持不变。结果：共分析了10头猪的77个病变，其中一致性病变38个，不一致性病变39个。接触力(18.0±3.2 g vs 17.6±3.5 g；P = 0.606)和基线阻抗(111.3±7.5 Ω vs 110.9±7.3 Ω；P = 0.782)，组间相似。DP一致性病变深度大于DP不一致性病变深度（7.4±1.8 vs 6.1±1.6 mm）；P = 0.001)和面积(72.5±22.2 mm2 vs 59.6±17.5 mm2；p = 0.006)。结论：将DP放置在体表与射频消融方向一致，可使病变深度增加~ 20%。这种简单的修改可以用来增强射频病变的大小。
Effect of Anterior vs Posterior Dispersive Patch Placement on Radiofrequency Ablation Lesion Size in Swine.
Background: Ablation of ventricular tachycardia using radiofrequency (RF) energy can be challenging for deep circuits. Standard RF ablation is monopolar, with energy delivered between the catheter and a dispersive patch (DP). Aligning the DP with the direction of RF application may shift the RF field to create deeper lesions.
Objectives: The authors sought to compare left ventricular lesion size with concordant (patch oriented in the direction of ablation) versus discordant DP placement in swine.
Methods: An irrigated, contact force sensing RF catheter was used to apply lesions to the anterior and posterior left ventricles in swine. Two DPs were attached, and the ground was randomly chosen so that one-half of the lesions were concordant (eg, anterior RF/anterior DP) and one-half were discordant (eg, anterior RF/posterior DP). Ablation parameters otherwise remained constant.
Results: A total of 77 lesions (38 concordant, 39 discordant) in 10 swine were analyzed. Contact force (18.0 ± 3.2 g vs 17.6 ± 3.5 g; P = 0.606) and baseline impedance (111.3 ± 7.5 Ω vs 110.9 ± 7.3 Ω; P = 0.782) were similar between groups. Lesions with concordant compared with discordant DP had greater lesion depth (7.4 ± 1.8 vs 6.1 ± 1.6 mm; P = 0.001) and area (72.5 ± 22.2 mm2 vs 59.6 ± 17.5 mm2; P = 0.006).
Conclusions: Placing the DP on the body surface concordant with the direction of RF ablation results in ∼20% increase in lesion depth. This simple modification can be used to enhance RF lesion size.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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