应用不同射频导管电极消融犬房室环处心肌组织的损伤范围及其相邻冠状动脉损伤的研究

目的 分析应用不同射频导管电极消融房室环处心肌组织的损伤范围及其邻近冠状动脉(冠脉)的损伤,评价其临床应用的安全性.方法 取成年犬21只,随机分为3个能量组:64℃、50 W、100 s,64℃、100 W、100 s,45℃、45 W、100 s;分别应用4、8 mm电极及冷盐水灌注电极进行消融(分别简称4 mm组、8 mm组和冷盐水组).每只犬分别消融左、右房室环各1处.实验结束后以1/6π×长×宽×深计算损伤体积并对损伤的心肌及冠脉组织进行光学显微镜病理学分析.结果 观察损伤深度:4mm组为(4.54±1.38)mm,8mm组为(7.18±1.72)mm,冷盐水组为(7.99±1.77)mm.统计学分析:4 mm组与8mm组和冷盐水组的组间相比,差异均具有统计学意义(P<0.01);后两组组间的差异无统计学意义.损伤体积:4mm组为(191.34±74.52)mm3,8mm组为(356.76 ±94.44)mm3,冷盐水组为(391.69±109.54)mm3;4mm组与8 mm组和冷盐水组的组间差异具有统计学意义(P<0.01),后两组组间差异无统计学意义.42处消融灶中有5处消融灶发生透壁性损伤.8处消融灶附近的冠脉发生病理性损伤,其中3处冠脉损伤明显.结论 应用8 mm及冷盐水灌注电极消融可使心肌损伤明显扩大,可以导致透壁性损伤,可以损伤邻近的冠脉.

Coronary artery and myocardium lesion comparison post atrioventricular ring radiofrequency catheter ablation with different catheters

Objective To analyze the extent of myocardium and coronary artery lesion post trioventricular ring radiofrequency catheter ablation with different tip catheters.Methods Twenty-one healthy dogs were randomly divided into 64℃/50 W/100 s,64 ℃/100 W/100 s,45 ℃/45 W/100 s groups and ablated by 4 mm tip catheter,8 mm tip catheter and irrigated tip catheter respectively.Left atrioventrieular ring and right atrioventricular ring ablation were performed in all dogs.After ablation,myocardium lesion volume was calculated as 1/6π × length × width × depth.Histological examinations were performed at the myocardium tissue at ablation sites.Results The lesion depths post 8 mm tip catheter ablation (7.18 ± 1.72) mm and irrigated tip catheter ablation (7.99 ± 1.77) mm were similar and significantly deeper than that post 4 mm tip catheter ablation (4.54 ± 1.38) ram,P<0.01.Similar results were found in terms of lesion volume (356.76 ± 94.44) mm3 post 8 mm tip catheter ablation,(391.69 ± 109.54)mm3 post irrigated tip catheter ablation and (191.34±74.52) mm3 post 4 mm tip catheter ablation].Five (5/42,11.9%) transmural myocardium necrosis and 8 (8/42,19%) coronary artery lesions were observed post ablations.Conclusion The extents of post ablation myoeardium and coronary artery lesion were significantly higher induced by 8 nun tip catheter and irrigate tip catheter compared those by 4 mm tip catheter.