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Europace Advance Access originally published online on December 10, 2008
Europace 2009 11(2):178-183; doi:10.1093/europace/eun333
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Electrophysiology and Ablation

Gradual power titration using radiofrequency energy: a safe method for slow-pathway ablation in the setting of atrioventricular nodal re-entrant tachycardia

Agustín Bortone1,2,*, Serge Boveda1, Serge Jandaud1, Nicolas Combes1, Jean-Pierre Donzeau1, Eloi Marijon1 and Jean-Paul Albenque1

1 Département de Rythmologie, Clinique Pasteur, 43-45 Avenue de Lombez, 31076 Toulouse, France; 2 Département de Rythmologie, Hôpital Privé Les Franciscaines, Nîmes, France

Aims: In the setting of atrioventricular nodal re-entrant tachycardia (AVNRT), radiofrequency (RF) catheter ablation of the slow-pathway (SP) ensures excellent outcome. However, the risk of complete heart block (CHB) remains real ({approx}1%) and detrimental. This study reports on a gradual power titration approach using RF energy, which allows a significant decrease in CHB occurrence.

Methods and results: Slow-pathway ablation was performed in 468 patients (mean age 43.8 ± 17.2 years, 311 women). Initial settings were 5 W, 60°C, 120 s (temperature-controlled mode). The power was increased by steps of 5 W for every 5 s until slow-accelerated junctional rhythm was obtained, and then further increased to 10 W maximum above this value. The acute success rate, the mean RF pulses applied per patient, and the average power delivered per successful RF applications were 99%, 3.2 ± 1.1, and 31.7 ± 3.0 W, respectively. There were nine (1.9%) transient and reversible AV blocks, and one (0.2%) permanent CHB only necessitating pacemaker insertion. The recurrence rate was 3.6% and the follow-up period was 28.1 ± 14.1 months.

Conclusion: Atrioventricular nodal re-entrant tachycardia RF ablation using gradual power titration is an efficient technique, capable of improving safety since it can decrease CHB occurrence.

Key Words: Radiofrequency energy, Slow-pathway ablation, Atrioventricular nodal re-entrant tachycardia, Gradual power titration, Complete heart block

* Corresponding author. Tel: +33 562211607, Fax: +33 562211641, Email: agubene{at}hotmail.com

Manuscript submitted 23 August 2008. Accepted after revision 11 November 2008.


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