Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Temperature-controlled radiofrequency catheter ablation of manifest accessory pathways
The Hospital of the Westfälische Wilhelms University of Münster, Department of Cardiology and Angiology and Institute for Research in Arteriosclerosis Münster, Germany
Received 22 May 1995; accepted 22 June 1995.
Correspondence: Martin Borggrefe, MD and Stephan Willems, MD, lnnere Medizin C, Universitätsklinik Münster, 48129 Münster, Germany
Abstract
OBJECTIVES: The primary objectives of this study were to assess the feasibility of temperature-controlled radiofrequency catheter ablation of left and right sided manifest accessory pathways in patients with Wolff-Parkinson-White syndrome and to gain more insights into biophysical aspects of temperature-controlled catheter ablation in humans.
BACKGROUND: The electrode-tissue interface temperature and other biophysical parameters are among important variables determining the efficacy and safety of radiofrequency ablation of accessory pathways. Experimental studies have shown that radiofrequency-induced tissue necrosis can be accurately predicted by monitoring of catheter tip temperature.
METHODS: 38 consecutive patients (14 f, 24 m; aged 42 ± 12 years) with anterograde conducting accessory pathways (left sided: n=22; right sided: n=l6) underwent temperature-controlled radiofrequency ablation (HAT 200S, Dr Osypka, Germany). The electrode temperature was monitored via a thermistor embedded into a 4 mm catheter tip. Power output was adjusted automatically during energy delivery in a closed loop system (preselected temp.: 70·1 ± 5·8°C).
RESULTS: Accessory pathway conduction was successfully abolished in all patients after the delivery of 2·3 ± 2·1 radiofrequency pulses (range: 1–9, median: 2). Interruption of the accessory pathway as evidenced by loss of preexcita tion occurred after 5·9 ± 5·4 s. At the time of the interruption of the accessory pathway the catheter tip temperature measured 54·2 ± 11· 2 ° C in patients with left and 44·9 ± 5·0° C in patients with right sided accessory pathways, respectively (P<0·008). Higher temperature levels during left sided applications did not shorten the time it took for the effect to appear (left sided accessory pathway: 7· 5 ± 6· 3 s, right sided accessory pathway: 3· 7 ± 2· 9 s; ns). The catheter tip temperature was significantly higher during left compared to right sided applications after 5 (52· 1 ± 3· 1 °C vs 47· 2 ± 4· 3 ° C) and 10s (61· 5 ± 6· 2 ° C vs 52· 7 ± 4· 2° C) following initiation of the impulse (P<0· 005). Power output and delivered energy did not differ significantly at the time of accessory pathway abolition. Peak values of delivered power (45· 1 ± 10· 9 W vs 41· 3 ± 10· 6W; P< 0· 05) and total delivered energy (2452 ± 1335 J vs 1392 ± 762 J; P<0· 02) were significantly higher in the group of right sided pathways compared to left sided applications. The peak temperature measured 77· 1 ± 13 °C during effec tive and 69· 9 ± 14 °C during ineffective energy applications (P<0· 05). The time it took for the effect to appear was significantly longer in transiently effective pulses (10· 4 ± 7· 2 s) compared to permanently effective applications (5· 9 ± 5· 4 s; P<0· 02). Despite temperature control, an abrupt rise in impedance was observed in 10 of 89 (11%) energy applications. No procedure-related complications occurred.
CONCLUSIONS: Temperature-controlled radiofrequency ablation of manifest accessory pathways is highly effective and safe. The temperature response is faster and signficantly higher in left-sided energy applications compared to right-sided pulses. Peak temperature levels measured at the electrode tip are significantly higher during effective than ineffective pulses. Sudden rises in impedance are not com pletely prevented during temperature-controlled radiofrequency ablation of accessory pathway, although no procedure-related complications were noted in this patient cohort.
(Eur Heart J 1996; 17: 445–452)
Key Words: WPW-syndrome • accessory pathways • temperature monitoring • radiofrequency catheter ablation
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