影响射频消融灶尺寸的若干因素研究
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摘要
探究三种独立因素(接触力、射频功率、作用时间)对于消融灶深度、直径的影响以及其数学模型。使用微孔(66孔)灌注导管,取新鲜猪心脏切片进行体外灌注消融,设定不同的接触力(10、15、20、25、30、35g)、射频功率(15、20、25 w)及作用时间(30、45、60 s),实验测得消融灶的深度和直径,并在现有研究结果的基础上,通过统计学软件对数据进行分析和拟合。三种独立因素和消融灶的深度、直径之间分别存在不同程度的正相关性,经数据拟合可得到其数学模型,且准确率较高。射频消融灶深度和直径与接触力、功率、时间三个独立因素之间存在某种确定的函数关系,可用于指导一定条件下的体外消融实验。
To study the influence of 3 independent factors(contact force,power,time) on the depth or diameter of the radiofrequency ablation lesions,and make up the mathematical models between them.The depths and diameters of ablation lesions on fresh porcine heart slices with irrigated catheter of 66 holes under contact force of 10 g,15 g,20 g,25 g,30 g,35 g,power of 15 w,20 w,25 w,time of 30 s,45 s and 60 s were measured,then analysed and data fitted with Minitab base on current findings.The result showed that there was a positive correlation between depth or diameter of the ablation lesions and the 3 independent factors,accuracy of the mathematic model getting from data fitting was ideal.The confirm functional relationship exists between depth or diameter of the radiofrequency ablation lesions and factors as contact force,radiofrequency power,acting time,and the mathematic model can be used to direct ex-vivo ablation experiments under particular conditions.
To study the influence of 3 independent factors(contact force,power,time) on the depth or diameter of the radiofrequency ablation lesions,and make up the mathematical models between them.The depths and diameters of ablation lesions on fresh porcine heart slices with irrigated catheter of 66 holes under contact force of 10 g,15 g,20 g,25 g,30 g,35 g,power of 15 w,20 w,25 w,time of 30 s,45 s and 60 s were measured,then analysed and data fitted with Minitab base on current findings.The result showed that there was a positive correlation between depth or diameter of the ablation lesions and the 3 independent factors,accuracy of the mathematic model getting from data fitting was ideal.The confirm functional relationship exists between depth or diameter of the radiofrequency ablation lesions and factors as contact force,radiofrequency power,acting time,and the mathematic model can be used to direct ex-vivo ablation experiments under particular conditions.
引文
[1]黄从新,马长生,杨延宗,等.心房颤动:目前的认识和治疗建议(二)[J].中华心律失常学杂志,2006,10(3):167-197.
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[5]Haverkamp W,Hindricks G,Gulker H,et al.Coagulation of ventricular myocardium using radiofrequency alternating current:biophysical aspects and experimental findings[J].Pacing&Clinical Electrophysiology,1989,12(1):187-195.
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[7]Aravinda T,Andre D,Lori F,et al.Importance of catheter contact force during irrigated radiofrequency ablation:evaluation in a porcine ex vivo model using a force-sensing catheter[J].Journal of Cardiovascular Electrophysiology,2010,21(7):806-811.
[8]Mark A,Scott M,Babar P,et al.Effect of electrode orientation on lesion sizes produced by irrigated radiofrequency ablation catheters[J].Journal of Electrophysiology,2009,20(11):1262-1268.
[9]Jose M.G,Esther J,Silvia R,et al.Effects of open-irrigated radiofrequency ablation catheter design on lesion formation and complications:in vitro comparison of 6 different devices[J].Journal of Cardiovascular Electrophysiology,2013,24(10):1157-1162.
[10]Ayman A,Carlos O,Oussama M,et al.Radiofrequency ablation with an enhanced-irrigation flexible-tip catheter versus a standard-irrigation rigid-tip catheter[J].Pacing&Clinical Electrophysiology,2015,38(10):1151-1158.
[11]Everett TH 4th,Lee K W,Wilson E E,et al.Safety profiles and lesion size of different radiofrequency ablation technologies:a comparison of large tip,open and closed irrigation catheters[J].Journal of Interventional Cardiac Electrophysiology,2009,20(3):325-335.
[12]Moreno J,Quintanilla J G,Molina Morúa R,et al.Morphological and thermodynamic comparison of the lesions created by 4 open-irrigated catheters in 2 experimental models[J].Journal of Cardiovascular Electrophysiology,2014,25(12):1391-1399.
[13]Nakagawa.Prospective study to test the ability to createRF lesion at predicted depths of 3,5,7 and 9 mm using a new formula incorporating contact force,radiofrequency power and application time(forcepower-time index)in the beating canine heart[R].Heart Rhythm Society,Heart Rhythm ON Demand:Novel Mapping and Ablation,2013.
[14]李鲁,林毅,王志鸿,等.射频消融毁损直径的扩展与延长消融时间的关系在离体牛干的研究[C].2010年北京胸外科年会论文集,2010.
[15]杨焰,罗葆明,智慧.冷循环射频消融输出功率及作用时间与凝固灶大小的关系[J].中国组织工程研究与临床康复,2007,11(26):5106-5108.
[16]Olson M D,Phreaner N,Schuller J L,et al.Effect of catheter movement and contact during application of radiofrequency energy on ablation lesion characteristics[J].Journal of Interventional Cardiac Electrophysiology,2013,38(2):123-129.
[2]马长生.心房颤动导管消融治疗:现状与展望[J].心电学杂志,2008,27(1):5-7.
[3]马长生.心房颤动治疗的现状与进展[J].中华医学杂志,2011,91(38):2665-2667.
[4]庄燕,陈明龙.房颤的射频消融治疗[J].东南大学学报(医学版),2014,33(4):531-536.
[5]Haverkamp W,Hindricks G,Gulker H,et al.Coagulation of ventricular myocardium using radiofrequency alternating current:biophysical aspects and experimental findings[J].Pacing&Clinical Electrophysiology,1989,12(1):187-195.
[6]Katsuaki Y,Hiroshi N,Dipen C,et al.Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus[J].Circulation Arrhythmia&Electrophysiology,2008,1(5):354-362.
[7]Aravinda T,Andre D,Lori F,et al.Importance of catheter contact force during irrigated radiofrequency ablation:evaluation in a porcine ex vivo model using a force-sensing catheter[J].Journal of Cardiovascular Electrophysiology,2010,21(7):806-811.
[8]Mark A,Scott M,Babar P,et al.Effect of electrode orientation on lesion sizes produced by irrigated radiofrequency ablation catheters[J].Journal of Electrophysiology,2009,20(11):1262-1268.
[9]Jose M.G,Esther J,Silvia R,et al.Effects of open-irrigated radiofrequency ablation catheter design on lesion formation and complications:in vitro comparison of 6 different devices[J].Journal of Cardiovascular Electrophysiology,2013,24(10):1157-1162.
[10]Ayman A,Carlos O,Oussama M,et al.Radiofrequency ablation with an enhanced-irrigation flexible-tip catheter versus a standard-irrigation rigid-tip catheter[J].Pacing&Clinical Electrophysiology,2015,38(10):1151-1158.
[11]Everett TH 4th,Lee K W,Wilson E E,et al.Safety profiles and lesion size of different radiofrequency ablation technologies:a comparison of large tip,open and closed irrigation catheters[J].Journal of Interventional Cardiac Electrophysiology,2009,20(3):325-335.
[12]Moreno J,Quintanilla J G,Molina Morúa R,et al.Morphological and thermodynamic comparison of the lesions created by 4 open-irrigated catheters in 2 experimental models[J].Journal of Cardiovascular Electrophysiology,2014,25(12):1391-1399.
[13]Nakagawa.Prospective study to test the ability to createRF lesion at predicted depths of 3,5,7 and 9 mm using a new formula incorporating contact force,radiofrequency power and application time(forcepower-time index)in the beating canine heart[R].Heart Rhythm Society,Heart Rhythm ON Demand:Novel Mapping and Ablation,2013.
[14]李鲁,林毅,王志鸿,等.射频消融毁损直径的扩展与延长消融时间的关系在离体牛干的研究[C].2010年北京胸外科年会论文集,2010.
[15]杨焰,罗葆明,智慧.冷循环射频消融输出功率及作用时间与凝固灶大小的关系[J].中国组织工程研究与临床康复,2007,11(26):5106-5108.
[16]Olson M D,Phreaner N,Schuller J L,et al.Effect of catheter movement and contact during application of radiofrequency energy on ablation lesion characteristics[J].Journal of Interventional Cardiac Electrophysiology,2013,38(2):123-129.