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Titolo:
TEMPERATURE-CONTROLLED RADIOFREQUENCY CATHETER ABLATION OF MANIFEST ACCESSORY PATHWAYS
Autore:
WILLEMS S; CHEN X; KOTTKAMP H; HINDRICKS G; HAVERKAMP W; ROTMAN B; SHENASA M; BREITHARDT G; BORGGREFE M;
Indirizzi:
UNIV MUNSTER,INNERE MED KLIN C D-48129 MUNSTER GERMANY HOSP WESTFAL WILHELMS UNIV MUNSTER,DEPT CARDIOL & ANGIOL MUNSTER GERMANY HOSP WESTFAL WILHELMS UNIV MUNSTER,INST ARTERIOSCLEROSIS RES MUNSTER GERMANY
Titolo Testata:
European heart journal
fascicolo: 3, volume: 17, anno: 1996,
pagine: 445 - 452
SICI:
0195-668X(1996)17:3<445:TRCAOM>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
VENTRICULAR MYOCARDIUM; ATRIOVENTRICULAR PATHWAYS; ALTERNATING-CURRENT; COAGULATION; IMPEDANCE;
Keywords:
WPW-SYNDROME; ACCESSORY PATHWAYS; TEMPERATURE MONITORING; RADIOFREQUENCY CATHETER ABLATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
19
Recensione:
Indirizzi per estratti:
Citazione:
S. Willems et al., "TEMPERATURE-CONTROLLED RADIOFREQUENCY CATHETER ABLATION OF MANIFEST ACCESSORY PATHWAYS", European heart journal, 17(3), 1996, pp. 445-452

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 biophysicalparameters are among important variables determining the efficacy andsafety of radiofrequency ablation of accessory pathways. Experimentalstudies have shown that radiofrequency-induced tissue necrosis can beaccurately 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 = 16) 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 degrees 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 preexcitation 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 degrees C in patients with left and 449 +/- 5.0 degrees 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 degrees C vs 47.2 +/- 4.3 degrees C) and 10 s (61.5 +/- 6.2 degrees C vs 52.7 +/- 4.2 degreesC) 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 +/- 10.6 W; P < 0.05) and total delivered energy (2452 +/- 1335J 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 degrees C during effective and 69.9 +/- 14 degrees 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 +/- 7.2s) 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 significantly 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 completely prevented during temperature-controlled radiofrequency ablation of accessory pathway, although no procedure-related complications were noted in this patient cohort.

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Documento generato il 25/09/20 alle ore 13:33:49