Comparison of ablation index versus time‐guided radiofrequency energy dosing using normal and half‐normal saline irrigation in a porcine left ventricular model

医学 烧蚀 生理盐水 病变 核医学 射频消融术 离体 导管消融 心脏病学 内科学 体内 外科 生物 生物技术
作者
Timothy R. Larsen,Jeanne M. Du‐Fay‐de‐Lavallaz,Jeffrey Winterfield,Venkatesh Ravi,Paul Rhodes,Jeremiah Wasserlauf,Richard G. Trohman,Parikshit S. Sharma,Henry D. Huang
出处
期刊:Journal of Cardiovascular Electrophysiology [Wiley]
卷期号:33 (4): 698-712 被引量:7
标识
DOI:10.1111/jce.15379
摘要

Ablation Index (AI) is a multiparametric quality marker to assess the durability of radiofrequency (RF) lesions. The comparative effectiveness and safety of AI versus time-based energy dosing for ablation of ventricular arrhythmias are unknown.We compared AI and time-based RF dosing strategies in the left ventricles (LVs) of freshly harvested porcine hearts.Ablation was performed in vitro with an open-irrigated ablation catheter (Thermocool ST/SF), 40 W, contact force 10-15 g. Tissue samples were stained in triphenyltetrazolium chloride for the measurement of lesion dimensions.A total of 560 lesions were performed (AI-group: [n = 360]; time-group: [n = 200]). Using normal saline (NS) (n = 280), growth in lesion depth slowed after 30 s and AI > 550 in comparison to width, volume, and magnitude of impedance drops which continued to increase with longer RF duration. Risk of steam pop (SP) was higher for RF > 30 s (RF < 30 s:1 SP [2.5%] vs. RF > 30 s: 15 SP [25%]; p = .002) or AI targets >550 (AI: 350-550: 2 SP [2%] vs. AI 600-750: 15 SP [19%]; p = .001). Using half-normal saline (HNS) (n = 280), lesion dimension and impedance drops were larger and growth in lesion depth slowed earlier (AI: 500). Risk of SPs was higher above AI 550 (AI: 350-550: 7 [7%] SPs vs. AI 600-750: 28 [35%] SPs; p < .00001). While codependent variables, correlation between AI and time was modest-to-strong but decreased with longer RF duration.In this ex vivo study, AI was a better predictor of lesion dimensions than ablation time and magnitude of impedance drop in the LV using NS and HNS irrigation. AI targets above 550 led to a higher risk of SPs. Future trials are required to verify these findings.
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