Circulation, Vol 90, 1279-1286, Copyright © 1994 by American Heart Association
H Calkins, E Prystowsky, M Carlson, LS Klein, JP Saul and P Gillette
BACKGROUND: The purpose of this study was to evaluate electrode
temperatures obtained using a radiofrequency ablation system that
incorporates closed loop feedback control to achieve preset target
electrode temperatures and to determine if closed loop temperature control
results in a lower incidence of developing a coagulum. METHODS AND RESULTS:
Two hundred seventy patients underwent catheter ablation of
atrioventricular nodal reentrant tachycardia, an accessory pathway, and/or
the atrioventricular junction using an ablation system incorporating closed
loop feedback control. Forty-five patients underwent catheter ablation in
the power control mode in which power output was fixed, and 225 patients
underwent catheter ablation in the temperature control mode. A coagulum
occurred during 0.8% of radiofrequency applications in the temperature
control mode versus 2.2% in the power control mode (P < .01). Electrode
temperatures were within 10 degrees C of the targeted temperature during
35% of applications in the temperature control mode. Ability to achieve the
targeted electrode temperature was related to the target, with
radiofrequency energy applications at the atrioventricular junction
resulting in the highest temperatures (70 +/- 12 degrees C) and those for
ablation of the atrioventricular node the lowest (59 +/- 11 degrees C, P
< .001), using a maximum of 50 W of power for both. Electrode
temperatures were higher during ablation of left free wall and
posteroseptal pathways than during ablation of right free wall and septal
pathways. The mean and minimum temperatures associated with success were 64
+/- 12 degrees C and 44 degrees C, respectively. Overall, the electrode
temperatures at successful and unsuccessful ablation sites did not differ
(P > .05). CONCLUSIONS: Temperature monitoring with closed loop control
of power output facilitates radiofrequency catheter ablation procedures by
minimizing the probability of developing a coagulum while ensuring maximum
lesion formation.
ARTICLES
Temperature monitoring during radiofrequency catheter ablation procedures using closed loop control. Atakr Multicenter Investigators Group
Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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