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Incidence and time course of intimal plaque formation in the right coronary artery after radiofrequency current application detected by intracoronary ultrasound

Häufigkeit und Manifestation von Intimaplaques der rechten Koronararterie nach Hochfrequenzstromapplikation

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Zusammenfassung

Hintergrund

Die Hochfrequenzstromablation gehört heute bei Kindern und Jugendlichen zum klinischen Standard. Allerdings sind die Spätfolgen der Energieapplikation am unreifen Myokard bislang unbekannt. Ziel der vorliegenden tierexperimentellen Untersuchung war es, die Häufigkeit und Manifestation von Läsionen der Koronararterien nach Hochfrequenzstromapplikation am unreifen Myokard darzustellen.

Methoden und Ergebnisse

Bei 10 jungen Schweinen (Alter im Mittel 6 Wochen, Gewicht im Mittel 13±2 kg) wurde Hochfrequenzstrom (500 kHz) mit einer Zieltemperatur von 75 °C über einen steuerbaren Elektrodenkatheter mit einer 4 mm-Spitzenelektrode über die Dauer von jeweils 30 s appliziert. Hochfrequenzstromläsionen wurden am lateralen rechten Vorhof unmittelbar am Trikuspidalklappenanulus sowie am lateralen linken Vorhof und linken Ventrikel unmittelbar am Mitralklappenanulus erzeugt. Alle Tiere wurden mittels selektiver Koronarangiographie sowie intrakoronarem Ultraschall der rechten Koronararterie (RCA) sowie des Ramus circumflexus (CX) 3, 6, 9 und 12 Monate nach der Energieapplikation nachuntersucht. Mit der quantitativen Koronarangiographie fanden sich keine Hinweise für signifikante Stenosen der beiden Gefäße. Initimaplaques der RCA (Fläche im Mittel 2,2±0,2 mm2, Lumeneinengung im Mittel 30,4±4%) wurden mit dem intrakoronaren Ultraschall erstmals 6 Monate nach der Hochfrequenzstromapplikation nachgewiesen. Das Ausmaß der Plaques zeigte sich in den nachfolgenden Untersuchungen unverändert. Bei allen 3 Tieren wurden die Stenosen der RCA im Rahmen der histologischen Untersuchungen 12 Monate nach der Energieabgabe bestätigt.

Schlussfolgerungen

Stenosierungen der RCA als Spätfolge der Hochfrequenzstromapplikation an der lateralen Vorhofwand wurde bei 3 der 8 langzeitüberlebenden Tiere nachgewiesen. Der Zeitrahmen für die Manifestation dieser Stenosen erstreckt sich über den Zeitraum von 3 bis 6 Monaten nach der Energieabgabe. Mit der selektiven Koronarangiographie konnten die Stenosen der RCA nicht dargestellt werden. Das Risiko der Entwicklung von Stenosierungen der Koronararterien sollte bei der Indikationsstellung zur Hochfrequenzstromablation bei Säuglingen und Kleinkindern beachtet werden.

Summary

Ergebnisse

Despite the current clinical use of radiofrequency (RF) catheter ablation in infants and children, the late effects of RF current application at immature myocardium remain unclear. The purpose of this study was to investigate incidence and time course of coronary lesions after RF current application at developing myocardium in an animal model.

Results

In 10 pigs, 6 weeks of age (13±2 kg), RF current (500 kHz) was delivered by temperature guidance (75 °C) using a steerable electrode catheter (4 mm tip electrode) over 30-second periods. RF lesions were created at the lateral right atrial wall at the tricuspid valve annulus and the lateral left atrial and ventricular wall at the mitral valve annulus. Subsequent coronary angiography and intracoronary ultrasound (ICUS) of the right coronary artery (RCA) and the left circumflex artery (CX) were performed 3, 6, 9 and 12 months after RF current application. Quantitative coronary angiography did not exhibit any significant stenosis of the vessels during the study period. Intimal lesions of the RCA were documented for the first time at the 6-month study in 3 animals by ICUS (mean plaque area 2.2±0.2 mm2, mean area stenosis 30.4±4.0%). There was no significant change in lesion length, area stenosis and plaque area at the 9- and 12-month studies. All 3 coronary artery lesions were confirmed in close proximity to myocardial RF lesions by histological examination 12 months after RF delivery. No intimal plaque formation of the CX was observed.

Conclusions

Affection of the RCA as a late sequel after RF current application at the lateral right atrial wall occurred in 3 out of 8 long-term surviving pigs. Three to six months seem to be the time frame for the development of intimal lesions after RF delivery. In this experimental setting, angiography failed to detect these intimal changes. The potential risk of coronary affection may be important for catheter ablation procedures at the right atrial myocardium in infants and small children.

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Authors and Affiliations

  1. Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    T. Paul

  2. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

    M. Sturm &  D. Hausmann

  3. Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany

    R. Bökenkamp,  H. Bertram,  G. Wibbelt &  T. Paul

Authors
  1. M. Sturm
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  2. D. Hausmann
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  3. R. Bökenkamp
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  4. H. Bertram
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  5. G. Wibbelt
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  6. T. Paul
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Correspondence to T. Paul.

Additional information

Supported by Deutsche Forschungsgemeinschaft grants PA 352/2-2 and PA 352/2–3

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Sturm, M., Hausmann, D., Bökenkamp, R. et al. Incidence and time course of intimal plaque formation in the right coronary artery after radiofrequency current application detected by intracoronary ultrasound. Z Kardiol 93, 884–889 (2004). https://doi.org/10.1007/s00392-004-0142-9

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  • DOI: https://doi.org/10.1007/s00392-004-0142-9

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