Initial low temperature setting in radiofrequency catheter ablation of Wolff-Parkinson-White syndrome

Previous studies have shown that with low temperature testing for RF ablation of arrhythmias, unnecessary irreversible myocardial lesions may be avoided. In children admitted for RF ablation from June 1996 to May 1999, we evaluated the method of an initial temperature setting of 50 degrees C for a maximum of 10 seconds. If accessory pathway block occurred, the temperature setting was immediately increased to 70 degrees C and continued for 45-120 seconds (group 1). If accessory pathway block did not occur after several attempts, subsequent attempts were made with initial settings at 70 degrees C-80 degrees C at the same or different sites (group 2). Eighty patients with Wolff-Parkinson-White syndrome (mean age 11 +/- 4 years) were treated using this method. Twelve patients were excluded for various reasons. Of the remaining 68 patients, 52 (76%) had successful block of the pathway at 50 degrees C; 16 patients demonstrated block only at the higher temperature setting of 70 degrees C-80 degrees C. There were no statistically significant differences between these two groups in terms of age, weight, and location of accessory pathways. Unsuccessful 50 degrees C test ablation attempts were 1.6 +/- 2.4 in group 1 and 3.1 +/- 2.9 in group 2 (P = 0.04). Total unsuccessful attempts were 1.6 +/- 2.4 in group 1 and 8.1 +/- 7.1 in group 2 (P = 0.001). The time from application of RF energy to the time of AP block in group 1 was not significantly different from group 2. In the majority of children, successful RF ablation can be achieved by using a temperature setting of 50 degrees C, then 70 degrees C. This will prevent unnecessary permanent injury at unsuccessful attempt sites.