Temperature-guided radiofrequency catheter ablation of accessory pathway

This study was performed to evaluate the usefulness of temperature-guided radiofrequency catheter ablation for the elimination of accessory pathway conduction in patients with Wolff-Parkinson-White syndrome.

Temperature-guided radiofrequency catheter ablation was attempted in 138 patients with 144 accessory pathways (88 pathways along the left free wall, 5 in the anteroseptal region, 2 in the midseptal region, 19 in the posteroseptal region and 30 along the right free wall). The energy source was a HAT 200S which regulated the power automatically to the set temperature of 70 degrees C. Radiofrequency current was delivered through a thermocatheter to the atrial or ventricular side of mitral or tricuspid annulus.

Accessory pathway conduction was eliminated in 130 of 144 pathways (90.3%). The mean power outputs of the successful ablations at the atrial side of the annulus were higher than those at the ventricular side (34.0 +/- 8.9W versus 20.0 +/- 7.6W, p < 0.01), but the maximum temperatures were lower at the atrial side of the annulus than those at the ventricular side (66.4 +/- 14.0 degrees C versus 77.2 +/- 6.4 degrees C, p < 0.01). There were 3 non-fatal complications (2.1%), 2 patients with hemopericardium and 1 with femoral artery thrombus, during or after ablation procedures. Recurrences of AV re-entrant tachycardia or delta wave on the electrocardiogram occurred in 4 patients (2.8%) who had successful second procedures. There were no late complications during a mean follow-up period of 41 +/- 25 months (range, 3 to 55).

We conclude that 1) temperature-guided radiofrequency catheter ablation can be performed reliably and safely in eliminating accessory pathway conduction in patients with WPW syndrome, and 2) temperature monitoring and adjustment of the power to the set temperature during ablation would be useful for the avoidance of impedance rises and coagulum formation.