TY - JOUR
T1 - Titration of Power Output During Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia
AU - LANGBERG, JONATHAN J.
AU - HARVEY, MARK
AU - CALKINS, HUGH
AU - EL‐ATASSI, RAFEL
AU - KALBELEISGH, STEVEN J.
AU - MORADY, FRED
PY - 1993/3
Y1 - 1993/3
N2 - Radiofrequency lesions in the anterior, superior aspect of the tricuspid annulus result in selective elimination of fast pathway function in patients with typical atrioventricular (AV) nodal reentry tachycardia. This technique is simple and effective, but has been associated with a significant risk of inadvertent complete AV block. The purpose of this study was to compare the safety and effectiveness of two different techniques for radiofrequency catheter ablation of the fast AV nodal pathway. Initially, a fixed power output was used at each target site. This method was compared retrospectively to a newer technique where power output was gradually incremented at each site. Radiofrequency power was initially applied at 10 watts for 10–15 seconds. If no junctional ectopy or a change in PR intervoi was seen, power output was incremented by 2 to 4 watts every 10 to 15 seconds up to a maximum of 30 watts. Thirty seven of 38 (96%) patients treated using this incremental power output were cured of their AV nodal reentry tachycardia. None of these patients developed inadvertent complete AV block. In contrast, 92% of historic controls treated with a fixed power output between 20 and 30 watts achieved a primary success and nine of these 89 (10%) historic controls developed inadvertent complete AV block (P = 0.04). There was no difference in the amplitudes of atrial, His, or ventricular electrograms at the effective sites between the two groups. Conclusions: (1) the anterior approach to radiofrequency catheter ablation of typical AV nodal reentry is associated with a significant risk of inadvertent complete AV block if a fixed power output is used; (2) starting at low power and gradually incrementing the output during radiofrequency energy application reduces the risk of complete AV block; (3) this incremental technique does not compromise efficacy.
AB - Radiofrequency lesions in the anterior, superior aspect of the tricuspid annulus result in selective elimination of fast pathway function in patients with typical atrioventricular (AV) nodal reentry tachycardia. This technique is simple and effective, but has been associated with a significant risk of inadvertent complete AV block. The purpose of this study was to compare the safety and effectiveness of two different techniques for radiofrequency catheter ablation of the fast AV nodal pathway. Initially, a fixed power output was used at each target site. This method was compared retrospectively to a newer technique where power output was gradually incremented at each site. Radiofrequency power was initially applied at 10 watts for 10–15 seconds. If no junctional ectopy or a change in PR intervoi was seen, power output was incremented by 2 to 4 watts every 10 to 15 seconds up to a maximum of 30 watts. Thirty seven of 38 (96%) patients treated using this incremental power output were cured of their AV nodal reentry tachycardia. None of these patients developed inadvertent complete AV block. In contrast, 92% of historic controls treated with a fixed power output between 20 and 30 watts achieved a primary success and nine of these 89 (10%) historic controls developed inadvertent complete AV block (P = 0.04). There was no difference in the amplitudes of atrial, His, or ventricular electrograms at the effective sites between the two groups. Conclusions: (1) the anterior approach to radiofrequency catheter ablation of typical AV nodal reentry is associated with a significant risk of inadvertent complete AV block if a fixed power output is used; (2) starting at low power and gradually incrementing the output during radiofrequency energy application reduces the risk of complete AV block; (3) this incremental technique does not compromise efficacy.
KW - radiofrequency catheter ablation
KW - reentrant tachycardia
KW - titration
UR - http://www.scopus.com/inward/record.url?scp=0027315799&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0027315799&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.1993.tb01609.x
DO - 10.1111/j.1540-8159.1993.tb01609.x
M3 - Article
C2 - 7681198
AN - SCOPUS:0027315799
SN - 0147-8389
VL - 16
SP - 465
EP - 470
JO - Pacing and Clinical Electrophysiology
JF - Pacing and Clinical Electrophysiology
IS - 3
ER -