Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy--a new method of catheter ablation

Closed chest catheter ablation of the atrioventricular (AV) junction has been performed with direct current or laser energy. The effect of 750 kHz radiofrequency energy on ablation of the AV junction was evaluated in 13 dogs. The radiofrequency energy was generated from an electrosurgical generator in the bipolar mode. The radiofrequency output was delivered between two distal electrodes (bipolar ablation) in eight dogs, and between the distal electrode and an external patch electrode (unipolar ablation) in another five dogs at varying power (watts) but with a constant pulse duration of 10 seconds. Complete AV block was achieved in 11 dogs and second degree AV block in 2. During the 4 to 7 day follow-up period, complete AV block persisted in 9 of the 11 dogs with initial complete heart block. The other two had return of AV conduction; one had persistent 2:1 AV block and the other had persistent first degree AV block. Of the two dogs with initial second degree AV block, one developed complete AV block, the other had resumption of 1:1 AV conduction with a normal PR interval. Energy was delivered in 1 to 13 applications per dog. One hundred to 700 J per application was delivered with bipolar ablation and 10 to 100 J with unipolar ablation. There was no damage to the catheter unless the catheter was repeatedly used in excess of 1,500 J of total energy. Ventricular arrhythmias were not observed. Pathologic examination showed well delineated coagulation necrosis at the AV junction without surrounding hemorrhage or mural thrombus. Microscopic findings consisted of necrosis with cell infiltration in the periphery of necrosis. Most injuries involved the AV node, the approaches to the AV node and the penetrating bundle. In conclusion, catheter ablation of the AV junction with radiofrequency energy is safe. It can effectively induce discrete areas of necrosis and produce various degrees of AV block. In addition, ablation by radiofrequency energy has distinct advantages as compared with catheter ablation with direct current or laser energy.

This article has been cited by other articles:

				R. E. Eckart and L. M. Epstein Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2008; 3(2008): 1357 - 1374. [Full Text]

				J. E. Marine Catheter Ablation Therapy for Supraventricular Arrhythmias JAMA, December 19, 2007; 298(23): 2768 - 2778. [Abstract] [Full Text] [PDF]

				C. M. Tracy, M. Akhtar, J. P. DiMarco, D. L. Packer, H. H. Weitz, M. A. Creager, D. R. Holmes Jr, G. Merli, G. P. Rodgers, C. M. Tracy, et al. American College of Cardiology/American Heart Association 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion: A Report of the American College of Cardiology/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training Developed in Collaboration With the Heart Rhythm Society J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1503 - 1517. [Full Text] [PDF]

				T. Dickfeld, R. Kato, M. Zviman, S. Lai, G. Meininger, A. C. Lardo, A. Roguin, D. Blumke, R. Berger, H. Calkins, et al. Characterization of Radiofrequency Ablation Lesions With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging J. Am. Coll. Cardiol., January 17, 2006; 47(2): 370 - 378. [Abstract] [Full Text] [PDF]

				J.S. Gill How to perform pulmonary vein isolation Europace, January 1, 2004; 6(2): 83 - 91. [Full Text] [PDF]

				S. D. Satti and L. M. Epstein Cardiologic Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1253 - 1270. [Full Text]

				C. Ozcan, A. Jahangir, P. A. Friedman, D. L. Hayes, T. M. Munger, R. F. Rea, M. A. Lloyd, D. L. Packer, D. O. Hodge, B. J. Gersh, et al. Sudden death after radiofrequency ablation of the atrioventricular node in patients with atrial fibrillation J. Am. Coll. Cardiol., July 3, 2002; 40(1): 105 - 110. [Abstract] [Full Text] [PDF]

				P. Bru, P. Lauribe, A. Rouane, M. Nadi, G. Prieur, P. Ricard, C. de Chillou, E. Aliot, and S. Levy Catheter ablation using very high frequency current: effects on the atrioventricular junction and ventricular myocardium in sheep Europace, January 1, 2002; 4(1): 69 - 75. [Full Text] [PDF]

				A. Erdogan, J. Carlsson, S. Grumbrecht, S. Kostin, B. Schulte, M. Schlapp, J. Neuzner, and H. F. Pitschner Electrochemical potentials during radiofrequency energy delivery: a new method to control catheter ablation of arrhythmias Europace, January 1, 2001; 3(3): 201 - 207. [Abstract] [PDF]

				C. M. Tracy, M. Akhtar, J. P. DiMarco, D. L. Packer, H. H. Weitz, W. L. Winters, J. L. Achord, A. W. Boone, J. W. Hirshfeld Jr, B. H. Lorell, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on invasive electrophysiology studies, catheter ablation, and cardioversion: A report of the american college of cardiology/american heart association/american college of physicians-american society of internal medicine task force on clinical competence J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1725 - 1736. [Full Text] [PDF]

				C. M. Tracy, M. Akhtar, J. P. DiMarco, D. L. Packer, H. H. Weitz, W. L. Winters, J. L. Achord, A. W. Boone, J. W. Hirshfeld Jr, B. H. Lorell, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion : A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence Circulation, October 31, 2000; 102(18): 2309 - 2320. [Full Text] [PDF]

				H. J. Marshall and M. J. Griffith Ablation of the atrioventricular junction: Technique, acute and long-term results in 115 consecutive patients Europace, January 1, 1999; 1(1): 26 - 29. [Abstract] [PDF]

				F GAITA, R RICCARDI, and L CALO Importance and implications of the occurrence of AV block following radiofrequency ablation Heart, June 1, 1998; 79(6): 534 - 535. [Full Text]

				S. G. Kim, V. Sompalli, A. Rameneni, M. K. Gadde, M. Pamidi, R. Pathapati, K. J. Ferrick, J. Gross, U. Ben-Zur, S. Furman, et al. Symptomatic Improvement After AV Nodal Ablation and Pacemaker Implantation for Refractory Atrial Fibrillation and Atrial Flutter Angiology, November 1, 1997; 48(11): 933 - 938. [Abstract] [PDF]

				S. M. Markowitz, B. L. Litvak, E. A. Ramirez de Arellano, J. A. Markisz, K. M. Stein, and B. B. Lerman Adenosine-Sensitive Ventricular Tachycardia : Right Ventricular Abnormalities Delineated by Magnetic Resonance Imaging Circulation, August 19, 1997; 96(4): 1192 - 1200. [Abstract] [Full Text]

				S.-A. Chen, S.-H. Lee, C.-E. Chiang, C.-T. Tai, T.-J. Wu, C.-C. Cheng, Z.-C. Wen, C.-W. Chiou, K.-C. Ueng, and M.-S. Chang Electrophysiological Mechanisms in Successful Radiofrequency Catheter Modification of Atrioventricular Junction for Patients With Medically Refractory Paroxysmal Atrial Fibrillation Circulation, May 1, 1996; 93(9): 1690 - 1701. [Abstract] [Full Text]

				J. Sra, M. Jazayeri, A. Natale, A. Dhala, Z. Blanck, S. Deshpande, C. Maglio, S. Bremner, and M. Akhtar Termination of Atrioventricular Nodal Reentrant Tachycardia by Premature Stimulation From Ablating Catheter : A Reliable Guide to Identify Site for Slow-Pathway Ablation Circulation, February 15, 1995; 91(4): 1095 - 1100. [Abstract] [Full Text]

				J. F. Alison, J. A. Yeung-Lai-Wah, M. Schulzer, and C. R. Kerr Characterization of Junctional Rhythm After Atrioventricular Node Ablation Circulation, January 1, 1995; 91(1): 84 - 90. [Abstract] [Full Text]

				B. D. Williamson, K. C. Man, E. Daoud, M. Niebauer, S. A. Strickberger, and F. Morady Radiofrequency Catheter Modification of Atrioventricular Conduction to Control the Ventricular Rate during Atrial Fibrillation N. Engl. J. Med., October 6, 1994; 331(14): 910 - 917. [Abstract] [Full Text]