A randomized comparison of fixed power and temperature monitoring during slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia.

Abstract

Temperature monitoring may be helpful for ablation of accessory pathways, however its role in ablation of atrioventricular nodal reentrant tachycardia (AVNRT) using the slow pathway approach is unclear. Therefore, the purpose of this study was to prospectively compare slow pathway ablation for AVNRT using fixed power or temperature monitoring. The study included 120 patients undergoing ablation for AVNRT. Patients were randomly assigned to receive either fixed power at 32 watts, or to temperature monitoring with a target temperature of 60 degrees C. The primary success rate was 72% in the fixed power group and 95% in the temperature monitoring group (p = 0.001). The ablation procedure duration (35 +/- 29 min vs 35 +/- 30 min; p = 0.9), fluoroscopic time (32 +/- 17 vs 35 +/- 19 min; p = 0.4), mean number of applications (10.2 +/- 8.1 vs 8.4 +/- 7.9; p = 0.2), and coagulum formation per application (0.2% vs 0.5%; p = 0.6) were statistically similar in the fixed power and temperature monitoring groups, respectively. The mean temperature (47.3 +/- 4.8 degrees C vs 48.6 +/- 3.8 degrees C; p < 0.01), and the temperature associated with junctional ectopy (48.2 +/- 3.8 degrees C vs 49.3 +/- 3.6 degrees C, p < 0.01) were less for the fixed power than the temperature monitoring group. In the temperature monitoring group, only 31% of applications achieved an electrode temperature of 60 degrees C. During follow up of 6.6 +/- 3.6 months there were two recurrences in the fixed power group and one in the temperature monitoring group (p = 1.0). In summary, power titration directed by temperature monitoring was associated with an improved primary procedural success rate. Applications of energy were associated with a temperature of approximately 50 degrees C with both techniques, suggesting that there is a low efficiency of heating in the posterior septum.