Circulation, Vol 86, 1469-1474, Copyright © 1992 by American Heart Association
JJ Langberg, H Calkins, R el-Atassi, M Borganelli, A Leon, SJ Kalbfleisch and F Morady
BACKGROUND. Animal studies have suggested that the temperature of the
electrode-tissue interface during radiofrequency catheter ablation
accurately predicts lesion size. The purpose of the current study was to
evaluate the utility of continuous temperature monitoring during
radiofrequency catheter ablation in patients with Wolff-Parkinson-White
syndrome. METHODS AND RESULTS. Twenty patients with manifest preexcitation
were included in the study. The ablation catheter was positioned on the
ventricular side of the mitral annulus for left-sided accessory pathways
and on the atrial side of the tricuspid annulus for right-sided and septal
accessory pathways. A thermistor imbedded in the distal electrode of the
ablation catheter allowed continuous temperature monitoring during each
energy application. To define the relation between power and temperature,
radiofrequency current was applied several times at each site using outputs
of 20, 30, 40, and 50 W. The accessory pathways were successfully ablated
in each of the 20 patients. Because of marked variability in the efficiency
of heating between sites, power output did not predict temperature.
However, at any given site, there was a positive dose-response relation
between power and temperature. Radiofrequency energy applications on the
atrial side of the tricuspid annulus produced lower temperatures than did
applications on the ventricular side of the mitral annulus (49 +/- 7 versus
60 +/- 16 degrees C, p = 0.0001). Transient block in the accessory pathways
occurred at a mean of 50 +/- 8 degrees C, whereas permanent block was seen
at a mean of 62 +/- 15 degrees C (p = 0.0001). Less than half of the
applications at outputs < or = 40 W produced temperatures adequate to
interrupt accessory pathway conduction. An abrupt rise in impedance caused
by coagulum formation occurred only at temperatures between 95 and 100
degrees C. CONCLUSIONS. Temperature monitoring may facilitate
radiofrequency catheter ablation of accessory pathways. By adjusting power
output to ensure that adequate but not excessive temperatures have been
achieved, a rise in impedance can be avoided and the total number of energy
applications and procedure duration may be reduced.
ARTICLES
Temperature monitoring during radiofrequency catheter ablation of accessory pathways
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
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