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Correlación de la temperatura y el efecto fisiopatológico durante la ablación del catéter de radiofrecuencia de la
S Nath1, J P DiMarco, J P Mounsey
1Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, USA.
Circulation
|September 1, 1995
Resumen
La ablación por radiofrecuencia de la unión AV puede inducir ritmos acelerados de unión y bloqueo nodal AV. Los sitios de ablación exitosos se caracterizan por la aparición rápida de estos ritmos y el bloqueo a temperaturas específicas.
Área de la Ciencia:
- Electrofisiología y electrofisiología.
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
Sus antecedentes:
- Los ritmos acelerados de unión a menudo preceden al bloqueo nodal AV durante la ablación por radiofrecuencia (RF) de la unión AV.
- El momento preciso y los umbrales de temperatura para inducir estos eventos siguen siendo caracterizados de manera incompleta.
Objetivo del estudio:
- Para caracterizar el curso de tiempo y los requisitos de temperatura para inducir el ritmo acelerado de unión y el bloqueo nodal AV durante la ablación RF de la unión AV.
Principales métodos:
- Diecinueve pacientes se sometieron a la ablación de RF utilizando un catéter de termistor con titulación de potencia incremental de hasta 50 W.
- Las aplicaciones de RF se entregaron durante 9 segundos, con una potencia aumentada en incrementos de 5 W.
- Las aplicaciones exitosas involucraron la entrega de RF en el nivel de potencia observado hasta que se produjo un bloqueo nodal AV o se aumentó aún más la potencia.
Principales resultados:
- La ablación de RF fue exitosa en los 19 pacientes, con una mediana de una aplicación necesaria para el bloqueo nódulo AV permanente.
- El ritmo acelerado de unión se produjo en el 89% de los intentos exitosos, con un tiempo medio de inicio de 1,8 segundos.
- El bloqueo nodal AV apareció significativamente más rápido durante las aplicaciones exitosas (19,6 segundos) frente a las no exitosas (36,8 segundos).
- Las temperaturas de la punta del catéter para el ritmo acelerado de unión (51 ° C) fueron más bajas que para el bloqueo nodal AV (58 ° C).
- El bloqueo nodal AV permanente requiere temperaturas medias alrededor de 60°C.
Conclusiones:
- El inicio rápido del ritmo acelerado de unión (dentro de 5 segundos) y el bloqueo nodal AV (dentro de 30 segundos) indican objetivos de ablación exitosos.
- Tanto el ritmo acelerado de unión como el bloqueo nodal AV son fenómenos altamente dependientes de la temperatura.
- Se requieren temperaturas más altas para inducir el bloqueo nodal AV en comparación con el ritmo acelerado de unión.
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