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Thermal Catheter Disruption During Closed‐Chest Radiofrequency Ablation of the Atrioventricular Conduction System
Author(s) -
FROHNER KLAUS J.,
PODCZECK ANDREA,
HIEF CHRISTINE,
NURNBERG MICHAEL,
STEINBACH KONRAD K.
Publication year - 1990
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1990.tb02097.x
Subject(s) - medicine , catheter , overheating (electricity) , ablation , catheter ablation , atrial fibrillation , electrode , radiofrequency ablation , surgery , atrioventricular block , biomedical engineering , anesthesia , cardiology , electrical engineering , chemistry , engineering
Radiofrequency ablation of the atrioventricular conduction system was attempted in a 63‐year‐old man with drug refractory atrial fibrillation. A total of 5 radiofrequency pulses (750 kHz, power setting: 25–50 W. pulse duration: 9–20 sec) were delivered in a unipolar fashion via the distal electrode of a 7 Fr bipolar electrode catheter without induction of permanent AV block. No direct measurements of current (I) and voltage (U) were made. During the fifth pulse catheter disruption occurred at the interface of the shaft and the proximal electrode. Inspection of the catheter shaft revealed carbonized insulation material indicating overheating of the catheter tip. Overheating was presumably due to an impedance rise with unrecognized clot formation on the distal electrode. This led to progressive melting of insulation material during repeated radiofrequency applications and short circuiting of current flow to the proximal ring electrode that resulted in catheter disruption. This case report is the first to describe a serious complication of radiofrequency ablation. The complication might have been prevented by measurements of U and I, reflecting changes in impedance or by measurements of catheter tip temperature (T). It is concluded that measurements of U, I, and/or T are necessary to control the coagulation process thereby reducing the risk of serious complications during transcatheter radiofrequency ablation.