利用射频消融法拔出起搏电极导线的实验研究

探索利用起搏电极导线直接释放射频能量到心肌组织是否可拔出起搏电极 ,多少能量合适。取新鲜猪心脏 ,切成条状心肌组织块 ,放置于盛有 37～ 38℃生理盐水的不锈钢碗中 ,碗底接射频背部电极 ,将单极导线(MedtronicCapsureSP 4 0 2 3)顶端压在心肌组织上 ,释放射频能量 ,方案为 1,2 ,3,4 ,5W ,时间为 3,6 ,9…… 2 1s,双极导线的顶端电极消融方案同单极电极。双极导线 (MedtronicCapsureSP 4 0 92 ,4 5 92 )的环圈电极放电为 8,10 ,12W ,时间为 5 ,10 ,15 ,2 0s消融后测损伤范围。结果 :单极导线放电 1W、12s,损伤范围是 2 .0± 0 .5mm× 1.7± 0 .6mm ,2W、6s,3W、3s其损伤范围分别是 2 .6± 0 .4mm× 2 .2± 0 .3mm ,2 .3± 0 .3mm× 2 .2± 0 .6mm ,4W、5W ,3s可引起明显心肌损伤。双极导线的顶端电极消融损伤范围与单极导线相比无统计学差异 (P >0 .0 5 )。心室双极导线的环圈电极放电 8W、2 0s ,10W、10s ,其损伤范围分别是 6 .3± 0 .6mm× 5 .0± 0 .0mm ,5 .5± 1.3mm× 4 .3± 0 .6mm。心房双极导线的环圈电极消融损伤范围与心室双极导线相比有统计学差异 (P <0 .0 5 )。结论 :利用起搏电极导线直接释放射频能量到心肌组织体外实验是可行的 ,这有可能成为拔除永久起搏导线的一种简单实用方法。

Experimental Study for Extraction of Pacemaker Lead Using Radiofrequency Ablation

The aim of our study is to investigate the feasibility and right radiofrequency( RF)energy for extraction of lead . Fresh pig heart tissue was put in stainless stee l bowel filling with 37～38℃ normal saline. The tip electrode of pacemaker lead (Medtro nic Capsure SP 4023, 4092, 4592) was pressed on cardiac muscle tissue, another polar of the lead was connected to RF apparatus, protocol of RF ablation as follow: Power was 1,2,3,4,5W; duration was 3,6,9……,21 s if it was unipolar or tip electrode of bipolar lead. Power was 8,10,12W, duration was 5,10,15, 20 s if it was ring electrode of bipolar lead. Lesion areas were measured after ablation.Results: When RF energy was released with 1 W、12 s,2 W、6 s,3 W、3 s using unipolar lead,the lesion areas were 2.0±0.5 mm×1.7±0.6 mm,2.6±0.4 mm×2.2±0.3 mm,2.3±0.3 mm×2.2±0.6 mm respectively. The lesion area of tip electrode of bipolar lead was the same as that of unipolar(P>0.05). when RF power was 10W, duration was 10s using ring electrode of ventricular bipolar lead, The lesion ar ea was 5.5±1.3 mm×4.3±0.6 mm. The lesion area of ring electrode of atrial bip loar lead was significant difference that of ventricle(P<0.05).Conclusion: This study suggests RF is delivered to cardiac muscle tissue by electrode and lead directly is feasible in vitro. It may be a simple and useful way for ex traction of pacemaker lead.