The interaction between the mapping/ablation catheter and left atrial (LA) myocardium potentially affects the LA electrical and mechanical properties and impacts on ablation efficacy. Using catheters able to provide real-time contact force (CF) measurement, it has become possible to explore these relationships in vivo. In 60 persistent atrial fibrillation (AF) patients, ablation CF was higher in the right than left wide area circumferential (WACA) lines and where steerable transseptal sheaths were used. Differences were also apparent in the burden of WACA segment reconnection but did not just reflect differences in ablation CFs, suggesting factors other than CF contribute to ablation efficacy. Relationships between ablation force time integral (FTI), impedance drop and electrogram attenuation were assessed in 15 persistent AF patients. FTI significantly correlated with electrogram attenuation and impedance drop from ablation. The relationship was stronger for the former but in both cases plateaued at 500g.s, suggesting no ablation efficacy gains beyond this. Factors further affecting CF and ablation efficacy, the latter judged by impedance drop, were assessed in 30 patients. The variability of the CF waveform and catheter locational stability were both affected by factors including atrial rhythm and catheter delivery mode. Greater CF variability, catheter drift and perpendicular catheter contact were associated with reduced ablation efficacy. The relationship between CF and the electrogram was assessed in 30 patients. The size of the electrogram complexes was affected by CF increases but only where initial CF was <10g. This was also the case for electrogram fractionation measurements. Increasing CF was associated with an increasing incidence of atrial ~ 3 ~ ectopics during sinus rhythm. Spectral parameters (dominant frequency and organisation index) were unaffected by CF. Various factors affect the contact between the catheter and LA myocardium. In turn, catheter contact significantly affects the electrogram during LA mapping and the efficacy of clinical radiofrequency ablation.

Orientadores: Jose Wilson Magalhães Bassani, Rosana Almada Bassani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Eletrica e de Computação / Made available in DSpace on 2018-08-06T07:47:18Z (GMT). No. of bitstreams: 1 Boer_DenileCominato_M.pdf: 557480 bytes, checksum: e378c01e865d04a595d3f0e7ad3c60dd (MD5) Previous issue date: 2006 / Resumo: Embora haja demonstração de que a estimulação simpática tenha efeito facilitatório sobre a indução de atividade espontânea em miocárdio há controvérsia sobre a participação dos tipos de adrenoceptores na mediação deste efeito. No presente trabalho, descrevemos um método desenvolvido para determinação, em átrio esquerdo isolado (AE) de rato, da relação concentração-efeito para agentes que exercem efeito arritmogênico por aumento da mobilização celular de 'Ca POT. 2+¿. O método baseou-se na interposição de pausas estimulatórias, durante as quais registraram-se contrações espontâneas (CE), precedidas ou não por trens estimulatórios de alta freqüência (5 Hz). O protocolo estimulatório foi repetido na presença de diferentes concentrações de agonistas. Para cada concentração de agonista, a resposta arrítmica foi considerada como a soma dos números de CE/min, no total de preparações. Foi analisada também a resposta inotrópica, como sendo o incremento de força ou encurtamento de pico, desenvolvidos em AE e miócitos ventriculares (MV), respectivamente. A relação foi ajustada por uma função sigmóide para cálculo de Min (i.e., valor da variável na ausência do agonista), Rmax (resposta máxima) e pD2 (-log da concentração do agonista que produziu uma resposta igual a 50% de Rmax). Este método foi aplicado no estudo dos tipos de adrenoceptores envolvidos na resposta arrítmica a catecolaminas em AE e MV. A Rmax inotrópica à ativação de adrenoceptores 'alfa IND. 1¿ + 'beta IND. 1¿ foi comparável àquela por ativação de apenas receptores 'beta IND. 1¿, em ambos AE e MV. Já a ativação de adrenoceptores 'alfa IND. 1¿ produziu uma Rmax inotrópica de apenas metade daquela observada pela estimulação 'alfa IND. 1¿ + 'beta IND. 1¿. Da mesma forma, a resposta arrítmica foi semelhante para estimulação de adrenoceptores a1+ß1 e de apenas receptores 'beta IND. 1¿. Entretanto, nenhuma resposta foi obtida pela estimulação de receptores adrenérgico do tipo 'alfa IND. 1¿. Estes resultados indicam que a estimulação de adrenoceptores 'alfa IND. 1¿, apesar de evocar uma resposta inotrópica positiva em ambos AE e MV, não é arritmogênica. A ativação do tipo 'beta¿, por outro lado, parece ser a principal via para estimulação inotrópica simpática e na indução de arritmias. Além disso, concluímos que parece existir antagonismo funcional entre os subtipos de adrenoceptores 'beta¿, manifestado por ações pró- e anti-arrítmicas dos subtipos 'beta IND. 1¿ e 'beta IND. 2¿, respectivamente, em miocárdio (tanto atrial, quanto ventricular) de rato / Abstract: Although it has been shown that sympathetic stimulation facilitates the appearance of myocardial spontaneous activity, it is still not clear which types of adrenoceptors mediate this effect. In this study, we describe a method developed for determination, in isolated rat atria (AE), of the concentration-effect relationship for arrhythmogenic agents that act via promotion of cell 'Ca POT. 2+¿ overload. The method was based on the interposition of stimulatory rest periods, during which spontaneous contractions (CE) were recorded, preceded or not by high frequency (5 Hz) stimulus trains. The stimulation protocol was applied at each agonist concentration, and the arrhythmic response was taken as the sum of the number of CE/min in all preparations. The positive inotropic response was considered as the agonist-dependent increment of developed force or peak shortening in AE and isolated ventricular myocytes (MV), respectively. Concentration-effect curves were determined by fitting a sigmoid function, from which the following parameters were estimated: Min (i.e., value of the variable in the absence of the agonist), Rmax (maximal response) e 'pD IND. 2¿ (-log of the molar agonist concentration that evokes a response equal to 50% of Rmax). This method was applied to investigate the adrenoceptor types involved in the mediation of catecholamine-induced arrhythmogenesis in AE and MV. Inotropic Rmax to activation of 'alfa IND. 1¿ + 'beta IND. 1¿ adrenoceptors was comparable to that of activation of solely 'beta IND. 1¿ adrenoceptors in both AE and MV. However, Rmax to selective 'alfa IND. 1¿ adrenoceptor activation was only half of that produced by 'alfa IND. 1¿ + 'beta IND. 1¿ adrenoceptor stimulation. The arrhythmic responses to 'alfa IND. 1¿ + 'beta IND. 1¿ and 'beta IND.1¿ receptor stimulation were similar, but selective a1 adrenoceptor activation was unable to evoke any spontaneous activity. The results indicate that a1 adrenoceptors, although able to mediate stimulation in both AE and MV, are not involved in arrhythmogenesis. 'beta¿-adrenoceptor activation, thus, seems the main type involved in both inotropic and arrhythmic responses to catecholamines. In addition, our results point out a functional antagonism between 'beta¿-adrenoceptor subtypes: i.e., pro- and anti-arrhythmic effects mediated by 'beta IND. 1¿ and 'beta IND. 2¿-adrenoceptors, respectively in both atrial and ventricular rat myocardium / Mestrado / Engenharia Biomedica / Mestre em Engenharia Elétrica

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