Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Temperature-controlled slow pathway ablation for treatment of atrioventricular nodal reentrant tachycardia using a combined anatomical and electrogram guided strategy
Hospital of the Westfälische Wilhelms University of Münster, Department of Cardiology and Angiology and Institute for Research in Arteriosclerosis Münster, Germany
revised 12 December 1995; accepted 5 January 1996.
Correspondence: Stephan Willems, MD, Martin Borggrefe, MD, Innere Medizin C, Uni Klinik Münster, D-48129 Münster, Germany
Abstract
AIMS: Anatomical and electrogram-guided techniques have been used separately for slow pathway ablation in atrioventricular nodal reentrant tachycardia. The aims of the present study were to analyse electrogram characteristics of target sites and biophysical parameters using a combined anatomical and electrogram-guided technique for temperature-controlled radiofrequency catheter ablation of the slow pathway.
METHODS AND RESULTS: Using a temperature-controlled (pre-selected 60 °C) catheter system, 53 patients with atrioventricular nodal reentrant tachycardia underwent slow pathway radiofrequency ablation. Mapping was started posteroseptally near the coronary sinus ostium and continued towards the midseptal area if needed. The longest and latest atrial electrograms with an atrioventricular ratio of 
0·5 were targeted. After a median of two pulses (mean 2·36 ± 1·33), atrioventricular nodal reentrant tachycardia was rendered non-inducible in all patients without complications. Successful sites had longer atrial electrograms (78·8 ± 9·8 vs 67·6 ± 13·3 ms, P<0·003) and larger ventricular electrogram amplitudes (92·4 ± 51·2 vs 63·1 ± 28·8 mV, P<0·05) than the failed sites, but had a similar atrioventricular ratio, P-A interval and atrial electrogram amplitude. Overall, an atrial electrogram duration of 
70 ms was associated with effective radiofrequency delivery, with 86% sensitivity and 62% specificity. The achieved temperature maximum was 62·3 ± 9·8 °C at successful and 58·8 ± 9·0 °C at unsuccessful sites (ns). There was no significant difference between successful and unsuccessful applications with respect to power output, impedance and total delivery energy. During a pre-discharge study, three patients with inducible atrioventricular nodal reentrant tachycardia underwent a repeat ablation. During 12·3 ± 2·5 (6–15) months of follow-up, three others had a clinical recurrence of atrioventricular nodal reentrant tachycardia.
CONCLUSIONS: The combined approach for slow pathway ablation is highly effective, requiring a low number of radiofrequency pulses. Long atrial activation time seems to be the most powerful predictor of success. Similar catheter tip temperature levels during successful and unsuccessful radiofrequency applications indicate that suboptimal selection of target sites rather than ineffective heating due to poor catheter tissue coupling is responsible for unsuccessful energy delivery.
Key Words: Catheter ablation • atrioventricular nodal reentrant tachycardia • slow pathway • supraventricular tachycardia • temperature control
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