Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes

W. M. Jackman, X. Wang, K. J. Friday, D. M. Fitzgerald, C. Roman, K. Moulton, P. D. Margolis, A. J. Bowman, K. H. Kuck, G. V. Naccarelli, J. V. Pitha, J. Dyer, R. Lazzara

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

Background. Two catheter electrode systems were compared for delivering radiofrequency current for ablation of the atrioventricular junction. Seventeen patients with drug-resistant supraventricular tachyarrhythmias were studied. Methods and Results. A 6F or 7F catheter with six or eight standard electrodes (1.25 mm wide, 2.5-mm spacing) was used in the first seven patients (group 1). A 7F quadripolar catheter with a large-tip electrode (4 mm long; surface area, 27 mm2) was used in the final 10 patients (group 2). Both ablation catheters were positioned to record a large atrial potential and a small but sharp His bundle potential from the distal bipolar electrode pair. Radiofrequency current was applied between a large skin electrode on the left posterior chest and either 1) each individual electrode on the standard-tip electrode catheter at 40 V (group 1) or 2) the large-tip electrode at 50-60 V (group 2). Radiofrequency current was limited to 40 V in group patients because of the strong potential for an early impedance rise when higher voltage is applied through standard electrodes. Complete atrioventricular block was achieved in six of seven group 1 patients and all 10 group 2 patients. A junctional escape rhythm followed ablation in five or six group 1 patients (mean cycle length, 1,066±162 msec) and eight of 10 group 2 patients (mean cycle length, 1,281±231 msec). Atrioventricular block was produced in a mean of 4.7±4.6 radiofrequency current applications delivered over a period of 42±45 minutes using the large-tip electrode (group 2) compared with 46±22 applications using standard electrodes (15.9±10.2 applications delivered through the standard-tip electrode) over a period of 147±59 minutes (group 1). For the application producing atrioventricular block, the large-tip electrode used higher voltage (58±17 versus 38±5 V, p<0.03) and had lower impedance (103±22 versus 148±40 Ω, p<0.01), resulting in greater power (33.0±13.0 versus 10.2±0.6 W, p<0.003) and shorter time to block (8±3 versus 22±3 seconds, p<0.001). Current delivery through standard electrodes was limited by an impedance rise occurring 7±7 seconds after the onset of one or more radiofrequency current applications at 10±1 W in six of seven patients. Using the large-tip electrode, an impedance rise occurred in five of 10 patients, but at 25±10 W and after 21±9 seconds. Atrioventricular block occurred before the impedance rise in three of these five patients. Complete atrioventricular block persisted in 15 of 16 patients at a mean follow-up of 8.7 months. Atrioventricular conduction returned at 1 month in one group 2 patient and was successfully ablated by a second procedure. Three group 1 patients died 0.5-2 months after ablation, and a fourth patient underwent cardiac transplantation after 10 months. Pathological examination of the heart in two of these patients showed necrosis of the atrioventricular node and origin of the His bundle, without injury to the middle or distal His bundle. All 10 group 2 patients are alive and subjectively improved after ablation. Conclusions. We conclude that catheter-delivered radiofrequency current effectively produces complete atrioventricular block (94%) without requiring general anesthesia or the risk of ventricular dysfunction or cardiac perforation. The large-tip electrode allows a threefold increase in delivered power and markedly decreases the number of pulses and time required to produce atrioventricular block.

Original languageEnglish (US)
Pages (from-to)1562-1576
Number of pages15
JournalCirculation
Volume83
Issue number5
DOIs
StatePublished - Jan 1 1991

Fingerprint

Catheter Ablation
Electrodes
Catheters
Atrioventricular Block
Electric Impedance
Bundle of His
Ventricular Dysfunction
Atrioventricular Node
Heart Transplantation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Jackman, W. M. ; Wang, X. ; Friday, K. J. ; Fitzgerald, D. M. ; Roman, C. ; Moulton, K. ; Margolis, P. D. ; Bowman, A. J. ; Kuck, K. H. ; Naccarelli, G. V. ; Pitha, J. V. ; Dyer, J. ; Lazzara, R. / Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes. In: Circulation. 1991 ; Vol. 83, No. 5. pp. 1562-1576.
@article{2b6f892f00634536ba06ff7e6e3f1530,
title = "Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes",
abstract = "Background. Two catheter electrode systems were compared for delivering radiofrequency current for ablation of the atrioventricular junction. Seventeen patients with drug-resistant supraventricular tachyarrhythmias were studied. Methods and Results. A 6F or 7F catheter with six or eight standard electrodes (1.25 mm wide, 2.5-mm spacing) was used in the first seven patients (group 1). A 7F quadripolar catheter with a large-tip electrode (4 mm long; surface area, 27 mm2) was used in the final 10 patients (group 2). Both ablation catheters were positioned to record a large atrial potential and a small but sharp His bundle potential from the distal bipolar electrode pair. Radiofrequency current was applied between a large skin electrode on the left posterior chest and either 1) each individual electrode on the standard-tip electrode catheter at 40 V (group 1) or 2) the large-tip electrode at 50-60 V (group 2). Radiofrequency current was limited to 40 V in group patients because of the strong potential for an early impedance rise when higher voltage is applied through standard electrodes. Complete atrioventricular block was achieved in six of seven group 1 patients and all 10 group 2 patients. A junctional escape rhythm followed ablation in five or six group 1 patients (mean cycle length, 1,066±162 msec) and eight of 10 group 2 patients (mean cycle length, 1,281±231 msec). Atrioventricular block was produced in a mean of 4.7±4.6 radiofrequency current applications delivered over a period of 42±45 minutes using the large-tip electrode (group 2) compared with 46±22 applications using standard electrodes (15.9±10.2 applications delivered through the standard-tip electrode) over a period of 147±59 minutes (group 1). For the application producing atrioventricular block, the large-tip electrode used higher voltage (58±17 versus 38±5 V, p<0.03) and had lower impedance (103±22 versus 148±40 Ω, p<0.01), resulting in greater power (33.0±13.0 versus 10.2±0.6 W, p<0.003) and shorter time to block (8±3 versus 22±3 seconds, p<0.001). Current delivery through standard electrodes was limited by an impedance rise occurring 7±7 seconds after the onset of one or more radiofrequency current applications at 10±1 W in six of seven patients. Using the large-tip electrode, an impedance rise occurred in five of 10 patients, but at 25±10 W and after 21±9 seconds. Atrioventricular block occurred before the impedance rise in three of these five patients. Complete atrioventricular block persisted in 15 of 16 patients at a mean follow-up of 8.7 months. Atrioventricular conduction returned at 1 month in one group 2 patient and was successfully ablated by a second procedure. Three group 1 patients died 0.5-2 months after ablation, and a fourth patient underwent cardiac transplantation after 10 months. Pathological examination of the heart in two of these patients showed necrosis of the atrioventricular node and origin of the His bundle, without injury to the middle or distal His bundle. All 10 group 2 patients are alive and subjectively improved after ablation. Conclusions. We conclude that catheter-delivered radiofrequency current effectively produces complete atrioventricular block (94{\%}) without requiring general anesthesia or the risk of ventricular dysfunction or cardiac perforation. The large-tip electrode allows a threefold increase in delivered power and markedly decreases the number of pulses and time required to produce atrioventricular block.",
author = "Jackman, {W. M.} and X. Wang and Friday, {K. J.} and Fitzgerald, {D. M.} and C. Roman and K. Moulton and Margolis, {P. D.} and Bowman, {A. J.} and Kuck, {K. H.} and Naccarelli, {G. V.} and Pitha, {J. V.} and J. Dyer and R. Lazzara",
year = "1991",
month = "1",
day = "1",
doi = "10.1161/01.CIR.83.5.1562",
language = "English (US)",
volume = "83",
pages = "1562--1576",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

Jackman, WM, Wang, X, Friday, KJ, Fitzgerald, DM, Roman, C, Moulton, K, Margolis, PD, Bowman, AJ, Kuck, KH, Naccarelli, GV, Pitha, JV, Dyer, J & Lazzara, R 1991, 'Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes', Circulation, vol. 83, no. 5, pp. 1562-1576. https://doi.org/10.1161/01.CIR.83.5.1562

Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes. / Jackman, W. M.; Wang, X.; Friday, K. J.; Fitzgerald, D. M.; Roman, C.; Moulton, K.; Margolis, P. D.; Bowman, A. J.; Kuck, K. H.; Naccarelli, G. V.; Pitha, J. V.; Dyer, J.; Lazzara, R.

In: Circulation, Vol. 83, No. 5, 01.01.1991, p. 1562-1576.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes

AU - Jackman, W. M.

AU - Wang, X.

AU - Friday, K. J.

AU - Fitzgerald, D. M.

AU - Roman, C.

AU - Moulton, K.

AU - Margolis, P. D.

AU - Bowman, A. J.

AU - Kuck, K. H.

AU - Naccarelli, G. V.

AU - Pitha, J. V.

AU - Dyer, J.

AU - Lazzara, R.

PY - 1991/1/1

Y1 - 1991/1/1

N2 - Background. Two catheter electrode systems were compared for delivering radiofrequency current for ablation of the atrioventricular junction. Seventeen patients with drug-resistant supraventricular tachyarrhythmias were studied. Methods and Results. A 6F or 7F catheter with six or eight standard electrodes (1.25 mm wide, 2.5-mm spacing) was used in the first seven patients (group 1). A 7F quadripolar catheter with a large-tip electrode (4 mm long; surface area, 27 mm2) was used in the final 10 patients (group 2). Both ablation catheters were positioned to record a large atrial potential and a small but sharp His bundle potential from the distal bipolar electrode pair. Radiofrequency current was applied between a large skin electrode on the left posterior chest and either 1) each individual electrode on the standard-tip electrode catheter at 40 V (group 1) or 2) the large-tip electrode at 50-60 V (group 2). Radiofrequency current was limited to 40 V in group patients because of the strong potential for an early impedance rise when higher voltage is applied through standard electrodes. Complete atrioventricular block was achieved in six of seven group 1 patients and all 10 group 2 patients. A junctional escape rhythm followed ablation in five or six group 1 patients (mean cycle length, 1,066±162 msec) and eight of 10 group 2 patients (mean cycle length, 1,281±231 msec). Atrioventricular block was produced in a mean of 4.7±4.6 radiofrequency current applications delivered over a period of 42±45 minutes using the large-tip electrode (group 2) compared with 46±22 applications using standard electrodes (15.9±10.2 applications delivered through the standard-tip electrode) over a period of 147±59 minutes (group 1). For the application producing atrioventricular block, the large-tip electrode used higher voltage (58±17 versus 38±5 V, p<0.03) and had lower impedance (103±22 versus 148±40 Ω, p<0.01), resulting in greater power (33.0±13.0 versus 10.2±0.6 W, p<0.003) and shorter time to block (8±3 versus 22±3 seconds, p<0.001). Current delivery through standard electrodes was limited by an impedance rise occurring 7±7 seconds after the onset of one or more radiofrequency current applications at 10±1 W in six of seven patients. Using the large-tip electrode, an impedance rise occurred in five of 10 patients, but at 25±10 W and after 21±9 seconds. Atrioventricular block occurred before the impedance rise in three of these five patients. Complete atrioventricular block persisted in 15 of 16 patients at a mean follow-up of 8.7 months. Atrioventricular conduction returned at 1 month in one group 2 patient and was successfully ablated by a second procedure. Three group 1 patients died 0.5-2 months after ablation, and a fourth patient underwent cardiac transplantation after 10 months. Pathological examination of the heart in two of these patients showed necrosis of the atrioventricular node and origin of the His bundle, without injury to the middle or distal His bundle. All 10 group 2 patients are alive and subjectively improved after ablation. Conclusions. We conclude that catheter-delivered radiofrequency current effectively produces complete atrioventricular block (94%) without requiring general anesthesia or the risk of ventricular dysfunction or cardiac perforation. The large-tip electrode allows a threefold increase in delivered power and markedly decreases the number of pulses and time required to produce atrioventricular block.

AB - Background. Two catheter electrode systems were compared for delivering radiofrequency current for ablation of the atrioventricular junction. Seventeen patients with drug-resistant supraventricular tachyarrhythmias were studied. Methods and Results. A 6F or 7F catheter with six or eight standard electrodes (1.25 mm wide, 2.5-mm spacing) was used in the first seven patients (group 1). A 7F quadripolar catheter with a large-tip electrode (4 mm long; surface area, 27 mm2) was used in the final 10 patients (group 2). Both ablation catheters were positioned to record a large atrial potential and a small but sharp His bundle potential from the distal bipolar electrode pair. Radiofrequency current was applied between a large skin electrode on the left posterior chest and either 1) each individual electrode on the standard-tip electrode catheter at 40 V (group 1) or 2) the large-tip electrode at 50-60 V (group 2). Radiofrequency current was limited to 40 V in group patients because of the strong potential for an early impedance rise when higher voltage is applied through standard electrodes. Complete atrioventricular block was achieved in six of seven group 1 patients and all 10 group 2 patients. A junctional escape rhythm followed ablation in five or six group 1 patients (mean cycle length, 1,066±162 msec) and eight of 10 group 2 patients (mean cycle length, 1,281±231 msec). Atrioventricular block was produced in a mean of 4.7±4.6 radiofrequency current applications delivered over a period of 42±45 minutes using the large-tip electrode (group 2) compared with 46±22 applications using standard electrodes (15.9±10.2 applications delivered through the standard-tip electrode) over a period of 147±59 minutes (group 1). For the application producing atrioventricular block, the large-tip electrode used higher voltage (58±17 versus 38±5 V, p<0.03) and had lower impedance (103±22 versus 148±40 Ω, p<0.01), resulting in greater power (33.0±13.0 versus 10.2±0.6 W, p<0.003) and shorter time to block (8±3 versus 22±3 seconds, p<0.001). Current delivery through standard electrodes was limited by an impedance rise occurring 7±7 seconds after the onset of one or more radiofrequency current applications at 10±1 W in six of seven patients. Using the large-tip electrode, an impedance rise occurred in five of 10 patients, but at 25±10 W and after 21±9 seconds. Atrioventricular block occurred before the impedance rise in three of these five patients. Complete atrioventricular block persisted in 15 of 16 patients at a mean follow-up of 8.7 months. Atrioventricular conduction returned at 1 month in one group 2 patient and was successfully ablated by a second procedure. Three group 1 patients died 0.5-2 months after ablation, and a fourth patient underwent cardiac transplantation after 10 months. Pathological examination of the heart in two of these patients showed necrosis of the atrioventricular node and origin of the His bundle, without injury to the middle or distal His bundle. All 10 group 2 patients are alive and subjectively improved after ablation. Conclusions. We conclude that catheter-delivered radiofrequency current effectively produces complete atrioventricular block (94%) without requiring general anesthesia or the risk of ventricular dysfunction or cardiac perforation. The large-tip electrode allows a threefold increase in delivered power and markedly decreases the number of pulses and time required to produce atrioventricular block.

UR - http://www.scopus.com/inward/record.url?scp=0025793953&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025793953&partnerID=8YFLogxK

U2 - 10.1161/01.CIR.83.5.1562

DO - 10.1161/01.CIR.83.5.1562

M3 - Article

C2 - 2022016

AN - SCOPUS:0025793953

VL - 83

SP - 1562

EP - 1576

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 5

ER -