TEMPERATURE MONITORING DURING RADIOFREQUENCY CATHETER ABLATION PROCEDURES USING CLOSED-LOOP CONTROL

被引：108

作者：

CALKINS, H ^{[1
]}

PRYSTOWSKY, E ^{[1
]}

CARLSON, M ^{[1
]}

KLEIN, LS ^{[1
]}

SAUL, JP ^{[1
]}

KAY, GN ^{[1
]}

DAILEY, S ^{[1
]}

EPSTEIN, A ^{[1
]}

PLUMB, V ^{[1
]}

WHARTON, M ^{[1
]}

KANTER, R ^{[1
]}

SORRENTINO, R ^{[1
]}

GREENFIELD, RA ^{[1
]}

WALSH, E ^{[1
]}

WALDO, A ^{[1
]}

BIBLO, L ^{[1
]}

JOHNSON, N ^{[1
]}

LIEBERMAN, R ^{[1
]}

ROSENBAUM, D ^{[1
]}

HUANG, SKS ^{[1
]}

MITTLEMAN, RS ^{[1
]}

WAGSHAL, AB ^{[1
]}

GREENE, T ^{[1
]}

LIEM, B ^{[1
]}

LAUER, M ^{[1
]}

SUNG, R ^{[1
]}

YOUNG, C ^{[1
]}

EVANS, J ^{[1
]}

CASE, C ^{[1
]}

HACKETT, K ^{[1
]}

MILES, W ^{[1
]}

ZIPES, D ^{[1
]}

LAWRENCE, J ^{[1
]}

TOMASELLI, G ^{[1
]}

BERGER, R ^{[1
]}

机构：

[1] JOHNS HOPKINS UNIV,SCH MED,DEPT INTERNAL MED,DIV CARDIOL,BALTIMORE,MD

来源：

CIRCULATION | 1994年 / 90卷 / 03期

关键词：

RADIOFREQUENCY; WOLFF-PARKINSON-WHITE SYNDROME; COAGULATION; CATHETER ABLATION;

D O I：

10.1161/01.CIR.90.3.1279

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1279 / 1286

页数：8

共 15 条

[1] ASSESSMENT OF EFFECTS OF A RADIOFREQUENCY ENERGY-FIELD AND THERMISTOR LOCATION IN AN ELECTRODE CATHETER ON THE ACCURACY OF TEMPERATURE-MEASUREMENT [J].

BLOUIN, LT ;

MARCUS, FI ;

LAMPE, L .

PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (05) :807-813

[2] RADIOFREQUENCY CATHETER ABLATION OF ACCESSORY ATRIOVENTRICULAR CONNECTIONS IN 250 PATIENTS - ABBREVIATED THERAPEUTIC APPROACH TO WOLFF-PARKINSON-WHITE SYNDROME [J].

CALKINS, H ;

LANGBERG, J ;

SOUSA, J ;

ELATASSI, R ;

LEON, A ;

KOU, W ;

KALBFLEISCH, S ;

MORADY, F .

CIRCULATION, 1992, 85 (04) :1337-1346

[3] THEORETICAL ASPECTS OF RADIOFREQUENCY LESIONS IN THE DORSAL-ROOT ENTRY ZONE [J].

COSMAN, ER ;

NASHOLD, BS ;

OVELMANLEVITT, J .

NEUROSURGERY, 1984, 15 (06) :945-950

[4]

DIECKMANN G, 1965, CONFIN NEUROL, V26, P134

[5] OBSERVATIONS ON ELECTRODE-TISSUE INTERFACE TEMPERATURE AND EFFECT ON ELECTRICAL-IMPEDANCE DURING RADIOFREQUENCY ABLATION OF VENTRICULAR MYOCARDIUM [J].

HAINES, DE ;

VEROW, AF .

CIRCULATION, 1990, 82 (03) :1034-1038

[6] TISSUE HEATING DURING RADIOFREQUENCY CATHETER ABLATION - A THERMODYNAMIC MODEL AND OBSERVATIONS IN ISOLATED PERFUSED AND SUPERFUSED CANINE RIGHT VENTRICULAR FREE WALL [J].

HAINES, DE ;

WATSON, DD .

PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1989, 12 (06) :962-976

[7]

HAINES DE, 1993, CIRCULATION, V88, P400

[8] RADIOFREQUENCY COAGULATION OF VENTRICULAR MYOCARDIUM - IMPROVED PREDICTION OF LESION SIZE BY MONITORING CATHETER TIP TEMPERATURE [J].

HINDRICKS, G ;

HAVERKAMP, W ;

GULKER, H ;

RISSEL, U ;

BUDDE, T ;

RICHTER, KD ;

BORGGREFE, M ;

BREITHARDT, G .

EUROPEAN HEART JOURNAL, 1989, 10 (11) :972-984

[9] CATHETER ABLATION OF ACCESSORY ATRIOVENTRICULAR PATHWAYS (WOLFF-PARKINSON-WHITE SYNDROME) BY RADIOFREQUENCY CURRENT [J].

JACKMAN, WM ;

WANG, XZ ;

FRIDAY, KJ ;

ROMAN, CA ;

MOULTON, KP ;

BECKMAN, KJ ;

MCCLELLAND, JH ;

TWIDALE, N ;

HAZLITT, HA ;

PRIOR, MI ;

MARGOLIS, PD ;

CALAME, JD ;

OVERHOLT, ED ;

LAZZARA, R .

NEW ENGLAND JOURNAL OF MEDICINE, 1991, 324 (23) :1605-1611

[10] SELECTIVE TRANSCATHETER ABLATION OF THE FAST AND SLOW PATHWAYS USING RADIOFREQUENCY ENERGY IN PATIENTS WITH ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA [J].

JAZAYERI, MR ;

HEMPE, SL ;

SRA, JS ;

DHALA, AA ;

BLANCK, Z ;

DESHPANDE, SS ;

AVITALL, B ;

KRUM, DP ;

GILBERT, CJ ;

AKHTAR, M .

CIRCULATION, 1992, 85 (04) :1318-1328

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