Parametri za vrednotenje kakovosti lezij pri zdravljenju atrijske fibrilacije z radiofrekvenčno ablacijo

BONČINA, JERNEJ (author), Jarm, Tomaž (mentor)

Atrijska fibrilacija je motnja srčnega ritma, ki zaradi naraščajoče pojavnosti postaja vse večji zdravstveni problem. Katetrska radiofrekvenčna ablacija je temeljna minimalno invazivna metoda zdravljenja, s katero poškodujemo ustje pljučnih ven v levem atriju ter s tem prekinemo električni prevod med levim atrijem in pljučnimi venami. Pri izvedbi radiofrekvenčne ablacije uporabljamo navigacijske programe, ki operaterju nudijo informacije o referenčnih vrednostih parametrov radiofrekvenčne ablacije, ki naj bi bile dosežene pri posegu. Kljub temu se še vedno pojavljajo primeri neuspešnih radiofrekvenčnih ablacij, kar pomeni, da s posegom ni bila dosežena popolna električna izolacija pljučnih ven. V raziskavi smo analizirali, ali se v parametrih radiofrekvenčne ablacije skriva informacija o kakovosti posameznih ablacijskih lezij. Za raziskavo smo uporabili podatke o parametrih radiofrekvenčne ablacije, zabeležene v elektronavigacijskem sistemu. Za ocenjevanje kakovosti ablacijskih lezij smo uporabili naslednje parametre: položaj katetra, silo stika konice ablacijskega katetra na srčno tkivo, impedanco tkiva, trajanje radiofrekvenčne ablacije, časovni integral sile stika in ablacijski indeks. Ablacijski indeks je izračunan z algoritmom, ki upošteva vrednosti več parametrov radiofrekvenčne ablacije (silo stika, moč dovajanja radiofrekvenčne energije in trajanje radiofrekvenčne ablacije). Ablacijske točke, ki so se nahajale na območjih ohranjenega električnega prevoda vzdolž ablacijske linije, smo označili kot slabe ablacijske točke. Ablacijske točke na segmentih ablacijske linije, kjer električnega prevoda ni bilo zaznati in so bile v neposredni bližini slabih točk, smo označili kot dobre ablacijske točke. Primerjali smo vrednosti izbranih parametrov med dobrimi in slabimi ablacijskimi točkami ter za nekatere od njih ugotovili statistično značilne razlike. Povprečna sila stika ablacijskega katetra na srčno tkivo je bila statistično značilno manjša pri dobrih ablacijskih točkah, trajanje radiofrekvenčne ablacije pa je bilo pri dobrih ablacijskih točkah značilno daljše.

• Language: Slovenian
• Keywords: atrijska fibrilacija, izolacija pljučnih ven, radiofrekvenčna ablacija, sila stika, analiza signalov ablacije
• Work type: Master's thesis/paper
• Organization: FE - Faculty of Electrical Engineering
• Year: 2026
• PID: 20.500.12556/RUL-181353
• Publication date in RUL: 02.04.2026

Secondary language

• Language: English
• Title: Parameters for quantification of lesion quality in radiofrequency ablation treatment of atrial fibrillation

Abstract

Atrial fibrillation is a heart rhythm disorder that, due to its increasing prevalence, is becoming an increasingly significant health problem. Catheter radiofrequency ablation is a fundamental minimally invasive treatment method in which the ostia of the pulmonary veins in the left atrium are damaged, thereby interrupting the electrical conduction between the left atrium and the pulmonary veins. During radiofrequency ablation, electroanatomical navigation systems are used to provide the operator with information about the radiofrequency ablation parameter reference values that should be achieved during the procedure. Despite this, cases of unsuccessful radiofrequency ablations still occur, meaning that complete electrical isolation of the pulmonary veins was not achieved during the procedure. In this study, we analyzed whether the parameters of radiofrequency ablation can provide us with information about the quality of individual ablation lesions. For the study, data on radiofrequency ablation parameters recorded in the electro-navigation system was used. The following parameters were used to evaluate the quality of ablation lesions: catheter position, contact force of the ablation catheter tip on the cardiac tissue, tissue impedance, duration of radiofrequency ablation, force-time integral, and ablation index. The ablation index is calculated using an algorithm that considers the values of several radiofrequency ablation parameters (contact force, power of radiofrequency energy delivery, and duration of radiofrequency ablation). Ablation points located in areas with preserved electrical conduction along the ablation line were labeled as poor quality ablation points. Ablation points on segments of the ablation line where no electrical conduction was detected and selected in the immediate vicinity of poor quality points, were labeled as good ablation points. We compared the values of selected parameters between good and poor quality ablation points and found statistically significant differences for some of them. The average contact force of the ablation catheter on cardiac tissue was significantly lower at good ablation points, while the duration of radiofrequency ablation was significantly longer.

• Keywords: atrial fibrillation, pulmonary vein isolation, radiofrequency ablation, contact force, ablation signal analysis