Temperature‐controlled Radiofrequency Catheter Ablation of Accessory Pathways and Atrioventricular Nodal Reentrant Tachycardia: The 5‐French Catheter Approach

Abstract

Ablation with Temperature‐Controlled 5‐French Catheters. Introduction: In the present study, we assessed the feasibility of radiofrequency (RF) ablation of accessory pathways and AV nodal reentrant tachycardias with novel 5‐French catheters with 4‐mm tip electrodes using established mapping criteria and temperature‐controlled power output control. Methods and Results: In this prospective study, 60 consecutive adult patients (mean age 36 ± 20 years) with accessory pathways (n = 37; 24 left‐sided) or AV nodal reentrant tachycardia (n = 23) underwent RF catheter ablation. A 5‐French catheter with a 4‐mm tip electrode and an embedded thermistor was used for RF application. The surface of the tip electrodes was 26 mm2 compared to 38 mm2 of 7‐French catheters with 4‐mm tip electrodes from the same catheter series. Power output was automatically and continuously adjusted according to the preset catheter tip temperature of 60° to 70°C. Pulse duration was 90 seconds. For left‐sided accessory pathways, the retrograde route via the femoral artery was used. After removing the 5‐French sheaths, only 4 hours of bed rest were advised. For ablation of AV nodal reentrant tachycardia, the so‐called slow pathway was targeted for ablation. Acute success was achieved in 34 (92%) of 37 patients with accessory pathways and 23 (100%) of 23 patients with AV nodal reentrant tachycardia. A mean of 3 ± 4 RF pulses (median 2 pulses; range 1 to 20 pulses) was applied. The mean fluoroscopy time was 26 ± 21 minutes. No complete AV block or other procedure‐related complications were observed. Recurrences occurred in 2 patients with accessory pathways and in 2 patients with AV nodal reentrant tachycardia during a follow‐up of 9 ± 4 months. Conclusions: Temperature‐controlled RF ablation of accessory pathways and AV nodal reentrant tachycardia in adults using 5‐French catheters is feasible, effective, and safe. Ablation with 5‐French catheters might help to reduce the complication rate of catheter ablation techniques.