Strickberger S A, Daoud E G, Weiss R, Brinkman K, Bogun F, Knight B P, Bahu M, Goyal R, Man K C, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
J Interv Card Electrophysiol. 1997 Dec;1(4):299-303. doi: 10.1023/a:1009733110281.
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.
温度监测可能有助于旁道消融，然而其在使用慢径路方法消融房室结折返性心动过速（AVNRT）中的作用尚不清楚。因此，本研究的目的是前瞻性比较使用固定功率或温度监测进行AVNRT慢径路消融的效果。该研究纳入了120例行AVNRT消融的患者。患者被随机分配接受32瓦的固定功率或目标温度为60℃的温度监测。固定功率组的主要成功率为72%，温度监测组为95%（p = 0.001）。固定功率组和温度监测组的消融手术持续时间（35±29分钟对35±30分钟；p = 0.9）、透视时间（32±17对35±19分钟；p = 0.4）、平均应用次数（10.2±8.1对8.4±7.9；p = 0.2）以及每次应用的凝块形成率（0.2%对0.5%；p = 0.6）在统计学上分别相似。固定功率组的平均温度（47.3±4.8℃对48.6±3.8℃；p < 0.01）以及与交界性早搏相关的温度（48.2±3.8℃对49.3±3.6℃，p < 0.01）低于温度监测组。在温度监测组中，仅31%的应用达到电极温度60℃。在6.6±3.6个月的随访期间，固定功率组有2例复发，温度监测组有1例复发（p = 1.0）。总之，由温度监测指导的功率滴定与提高主要手术成功率相关。两种技术的能量应用均与约50℃的温度相关，提示后间隔加热效率较低。
