Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch

Importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site

Jiunn Lee Lin, Shoei K.Stephen Huang, Ling Ping Lai, Ting Fu Cheng, Yung Zu Tseng, Wen Pin Lien

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Radiofrequency (RF) catheter ablation of accessory atrioventricular (AV) connections in the proximity of His bundle or AV node is at high risk of developing complete heart block. A safe and effective protocol has not been well established. Nineteen consecutive patients with 19 septal accessory pathways within the triangle of Koch underwent a protocol with power-titrated RF energy testing to identify the target site for successful catheter ablation. At every potential target site preselected by local electrogram characteristics, RF energy was started at 5 W for 10 seconds, with an increment of 5 W (duration remained at 10 s) until maximally 30 W or the observation of transient interruption of accessory pathway conduction. By this stepwise RF energy testing, we successfully localized and ablated 18 (94.7%) of the 19 septal accessory pathways, 10 close to His bundle (zone I) and 8 away from it (zone II). The test-effective RF power was 20 W or less in 9 of all 11 septal accessory pathways in zone I, and 5 of the 8 in zone II (P = 0.68). Meanwhile, the final RF power for successful ablation was 30 W or less in 9 of the 10 zone 1 and 6 of the 8 zone II septal accessory pathways (P = 0.83). One patient with an accessory pathway in zone I was complicated with complete AV block after final ablation at 30 W. None of the local electrogram characteristics except continuous electrical activity during retrograde mapping was helpful in the prediction of ablation outcome. Careful RF energy titration testing could effectively help identify the target site for successful RF catheter ablation of septal accessory pathways within the triangle of Koch. The dependence on local electrogram manifestations could be frustrated by a low probability of success.

Original languageEnglish
Pages (from-to)1909-1917
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume21
Issue number10
DOIs
Publication statusPublished - Oct 15 1998
Externally publishedYes

Fingerprint

Catheter Ablation
Bundle of His
Atrioventricular Node
Heart Block
Atrioventricular Block
Observation

Keywords

  • Complete heart block
  • Radiofrequency catheter ablation
  • Septal accessory pathway
  • Triangle of Koch

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch : Importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site. / Lin, Jiunn Lee; Huang, Shoei K.Stephen; Lai, Ling Ping; Cheng, Ting Fu; Tseng, Yung Zu; Lien, Wen Pin.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 21, No. 10, 15.10.1998, p. 1909-1917.

Research output: Contribution to journalArticle

@article{caabc139d56247ac9d308ced53d1b3bf,
title = "Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch: Importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site",
abstract = "Radiofrequency (RF) catheter ablation of accessory atrioventricular (AV) connections in the proximity of His bundle or AV node is at high risk of developing complete heart block. A safe and effective protocol has not been well established. Nineteen consecutive patients with 19 septal accessory pathways within the triangle of Koch underwent a protocol with power-titrated RF energy testing to identify the target site for successful catheter ablation. At every potential target site preselected by local electrogram characteristics, RF energy was started at 5 W for 10 seconds, with an increment of 5 W (duration remained at 10 s) until maximally 30 W or the observation of transient interruption of accessory pathway conduction. By this stepwise RF energy testing, we successfully localized and ablated 18 (94.7{\%}) of the 19 septal accessory pathways, 10 close to His bundle (zone I) and 8 away from it (zone II). The test-effective RF power was 20 W or less in 9 of all 11 septal accessory pathways in zone I, and 5 of the 8 in zone II (P = 0.68). Meanwhile, the final RF power for successful ablation was 30 W or less in 9 of the 10 zone 1 and 6 of the 8 zone II septal accessory pathways (P = 0.83). One patient with an accessory pathway in zone I was complicated with complete AV block after final ablation at 30 W. None of the local electrogram characteristics except continuous electrical activity during retrograde mapping was helpful in the prediction of ablation outcome. Careful RF energy titration testing could effectively help identify the target site for successful RF catheter ablation of septal accessory pathways within the triangle of Koch. The dependence on local electrogram manifestations could be frustrated by a low probability of success.",
keywords = "Complete heart block, Radiofrequency catheter ablation, Septal accessory pathway, Triangle of Koch",
author = "Lin, {Jiunn Lee} and Huang, {Shoei K.Stephen} and Lai, {Ling Ping} and Cheng, {Ting Fu} and Tseng, {Yung Zu} and Lien, {Wen Pin}",
year = "1998",
month = "10",
day = "15",
doi = "10.1111/j.1540-8159.1998.tb00010.x",
language = "English",
volume = "21",
pages = "1909--1917",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch

T2 - Importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site

AU - Lin, Jiunn Lee

AU - Huang, Shoei K.Stephen

AU - Lai, Ling Ping

AU - Cheng, Ting Fu

AU - Tseng, Yung Zu

AU - Lien, Wen Pin

PY - 1998/10/15

Y1 - 1998/10/15

N2 - Radiofrequency (RF) catheter ablation of accessory atrioventricular (AV) connections in the proximity of His bundle or AV node is at high risk of developing complete heart block. A safe and effective protocol has not been well established. Nineteen consecutive patients with 19 septal accessory pathways within the triangle of Koch underwent a protocol with power-titrated RF energy testing to identify the target site for successful catheter ablation. At every potential target site preselected by local electrogram characteristics, RF energy was started at 5 W for 10 seconds, with an increment of 5 W (duration remained at 10 s) until maximally 30 W or the observation of transient interruption of accessory pathway conduction. By this stepwise RF energy testing, we successfully localized and ablated 18 (94.7%) of the 19 septal accessory pathways, 10 close to His bundle (zone I) and 8 away from it (zone II). The test-effective RF power was 20 W or less in 9 of all 11 septal accessory pathways in zone I, and 5 of the 8 in zone II (P = 0.68). Meanwhile, the final RF power for successful ablation was 30 W or less in 9 of the 10 zone 1 and 6 of the 8 zone II septal accessory pathways (P = 0.83). One patient with an accessory pathway in zone I was complicated with complete AV block after final ablation at 30 W. None of the local electrogram characteristics except continuous electrical activity during retrograde mapping was helpful in the prediction of ablation outcome. Careful RF energy titration testing could effectively help identify the target site for successful RF catheter ablation of septal accessory pathways within the triangle of Koch. The dependence on local electrogram manifestations could be frustrated by a low probability of success.

AB - Radiofrequency (RF) catheter ablation of accessory atrioventricular (AV) connections in the proximity of His bundle or AV node is at high risk of developing complete heart block. A safe and effective protocol has not been well established. Nineteen consecutive patients with 19 septal accessory pathways within the triangle of Koch underwent a protocol with power-titrated RF energy testing to identify the target site for successful catheter ablation. At every potential target site preselected by local electrogram characteristics, RF energy was started at 5 W for 10 seconds, with an increment of 5 W (duration remained at 10 s) until maximally 30 W or the observation of transient interruption of accessory pathway conduction. By this stepwise RF energy testing, we successfully localized and ablated 18 (94.7%) of the 19 septal accessory pathways, 10 close to His bundle (zone I) and 8 away from it (zone II). The test-effective RF power was 20 W or less in 9 of all 11 septal accessory pathways in zone I, and 5 of the 8 in zone II (P = 0.68). Meanwhile, the final RF power for successful ablation was 30 W or less in 9 of the 10 zone 1 and 6 of the 8 zone II septal accessory pathways (P = 0.83). One patient with an accessory pathway in zone I was complicated with complete AV block after final ablation at 30 W. None of the local electrogram characteristics except continuous electrical activity during retrograde mapping was helpful in the prediction of ablation outcome. Careful RF energy titration testing could effectively help identify the target site for successful RF catheter ablation of septal accessory pathways within the triangle of Koch. The dependence on local electrogram manifestations could be frustrated by a low probability of success.

KW - Complete heart block

KW - Radiofrequency catheter ablation

KW - Septal accessory pathway

KW - Triangle of Koch

UR - http://www.scopus.com/inward/record.url?scp=0031709583&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031709583&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8159.1998.tb00010.x

DO - 10.1111/j.1540-8159.1998.tb00010.x

M3 - Article

VL - 21

SP - 1909

EP - 1917

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 10

ER -