Circulation, Vol 80, 1527-1535, Copyright © 1989 by American Heart Association
JJ Langberg, MC Chin, M Rosenqvist, J Cockrell, N Dullet, G Van Hare, JC Griffin and MM Scheinman
Catheter ablation of the atrioventricular junction using direct-current
defibrillator discharges requires general anesthesia and may have serious
side effects. Sixteen patients with drug-refractory supraventricular
tachycardia underwent catheter ablation of the atrioventricular junction
using radiofrequency energy. A standard 7F quadripolar electrode catheter
was positioned to record the largest unipolar His potential (580 +/- 640
microV) from the distal electrode. An electrocoagulator (Microvasive Bicap
4005) supplied continuous, unmodulated energy at 550 kHz. One to 14
applications of radiofrequency current were delivered between the distal
electrode and a large- diameter chest wall electrode. Transient, mild chest
discomfort was reported by seven of 16 patients. None had significant
arrhythmias or blood pressure changes during radiofrequency ablation.
Complete atrioventricular block was produced in nine of 16 patients and
high- grade second-degree atrioventricular block was produced in one
patient with radiofrequency current. Attenuated His bundle electrograms
could still be recorded in the remaining six patients, four of whom
underwent successful atrioventricular junctional ablation using
direct-current shock during the same session. Atrioventricular block
persisted in all 10 patients successfully treated with radiofrequency
ablation during a mean follow-up of 4.2 months. Compared with a group of
historic control subjects treated with direct-current shock ablation, the
10 patients successfully treated with radiofrequency current had
significantly less creatine kinase-MB isoenzyme release (5.7 +/- 5.1 vs. 22
+/- 13 IU, p = 0.006). A junctional escape rhythm was present in all
patients after radiofrequency-induced atrioventricular block. In contrast,
three of 10 control patients had an idioventricular escape after direct
current shock ablation, and four patients had no escape rhythm at
all.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Catheter ablation of the atrioventricular junction with radiofrequency energy
Department of Medicine, University of California, San Francisco.
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