Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
Temperature-controlled radiofrequency catheter ablation of AV conduction: first clinical experience
Department of Medicine, University of Munich Munich, Germany
Received 23 December 1991; revised 7 July 1992; .
Correspondence: Dr Ellen Hoffmann, Klinikum Grosshadern, Med. Klinik I, Marchioninistrasse l5, D8000 München 70, Germany
Abstract
A new technique for catheter ablation of atrioventricular (AV) conduction, using temperature-controlled radiofrequency energy and a bipolar asymmetrical electrode configuration, was applied to 12 patients (mean age, 48 ± 15 years; range, 18–69 years) with medically refractory atrioventricular nodal reentrant tachycardia (AVNRT) or rapid atrial rhythms. The energy source was a 500 kHz generator with automatic power regulation to a preselected temperature of 80 °C. A specially designed 7 F bipolar asymmetric thermo-catheter was used for ablation in all cases. The endpoints of the procedure were: first-degree AV block in patients with AVN R T and third-degree block in patients with atrial fibrillation or flutter. Energy was applied over a range of 1–14 times per patient. After a mean follow-up of 8±4 months, third- or first degree AV block persisted in eight patients. In comparison to constant-power radiofrequency ablation, where impedance rises are commonly observed, no impedance rise or coating of the electrode occurred during any of the 97 energy applications in this study. Variable wall contact of the electrode was identified in 20 of 97 applications by a slow temperature rise or a drop in temperature and frequent power adjustments. Thus, monitoring temperature and automatic power regulation may help to reduce the total delivered energy. Temperature control during radiofrequency energy avoids coagulum formation and consequently the associated potential hazards of constant-power application.
Key Words: Radiofrequency energy • catheter ablation • temperature control • supraventricular tachycardias • Av node
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