Area Under the Real‐Time Contact Force Curve (Force–Time Integral) Predicts Radiofrequency Lesion Size in an In Vitro Contractile Model

FTI Predicts RF Lesion Size in Contractile Model. Introduction: Electrode tissue contact, radiofrequency (RF) power and duration are major determinants of RF lesion size. Since contact forces (CF) vary in the beating heart, we evaluated contact force–time integral (FTI) as a predictor of lesion size at constant RF power in a contractile bench model simulating the beating heart. Methods and Results: An open‐tip irrigated catheter was attached to a movable mount incorporating a dynamic force sensor allowing closed loop control to achieve desired force variations between the catheter tip and bovine skeletal muscle placed on a ground plate. RF energy (20 and 40 W for 60 seconds, 17 cc/min irrigation) was delivered during (1) constant contact (C) at 20 g, (2) variable contact (V) with a 20 g peak and 10 g nadir, and (3) intermittent contact (I) with a 20 g peak and 0 g nadir with loss of contact. V and I protocols were performed at 50 and 100 catheter movements/min and 2 systole:diastole time ratios (50:50 and 30:70). The area under the CF curve was calculated as the FTI. Measured FTI was highest in C, intermediate during V and lowest during I and correlated linearly with lesion volume (P < 0.0001 for 20 and 40 W). Lesion volume was highest in group C, intermediate in V and lowest in group I (P < 0.05 for C vs V, V vs I, and C vs I). Conclusions: Lesion size correlates linearly with measured contact FTI. Constant contact produces the largest and intermittent contact the smallest lesions despite constant RF power and identical peak contact forces. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1038‐1043, September 2010)     

Intestinal Perforation in a Two-Year-Old Child with Eosinophilic Gastroenteritis

ABSTRACT. A two-year-old boy underwent a laparatomy for an intestinal perforation due to eosinophilic gastroenteritis. He had marked peripheral blood eosinophilia and a small duodenal biopsy showed heavy eosinophilic infiltration in the mucosa. After 1 1/2 year on a restricted diet, a control duodenal biopsy showed only slight eosinophilia. Perforation of the small intestine is a rare but serious complication in eosinophilic gastroenteritis.