title: Efficacy and safety of an irrigated-tip catheter for the ablation of accessory pathways resistant to conventional radiofrequency ablation.
abstract: BACKGROUND
  Radiofrequency catheter ablation of accessory pathways (APs) is very effective in all but a minority of patients. We examined the usefulness and safety of irrigated-tip catheters in treating patients with APs resistant to conventional catheter ablation.
  
  
  RESULTS
  Among 314 APs in 301 consecutive patients, conventional ablation failed to eliminate AP conduction in 18 APs in 18 patients (5.7%), 6 of which were located in the left free wall, 5 in the middle/posterior-septal space, and 7 inside the coronary sinus (CS) or its tributaries. Irrigated-tip catheter ablation was subsequently performed with temperature control mode (target temperature, 50 degrees C), a moderate saline flow rate (17 mL/min), and a power limit of 50 W (outside CS) or 20 to 30 W (inside CS) at previously resistant sites. Seventeen of the 18 resistant APs (94%) were successfully ablated with a median of 3 applications using irrigated-tip catheters. A significant increase in power delivery was achieved (20.3+/-11.5 versus 36.5+/-8.2 W; P:<0.01) with irrigated-tip catheters, irrespective of the AP location, particularly inside the CS or its tributaries. No serious complications occurred.
  
  
  CONCLUSIONS
  Irrigated-tip catheter ablation is safe and effective in eliminating AP conduction resistant to conventional catheters, irrespective of the location.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
authors.forename: T
authors.initials: T
authors.lastname: Yamane
authors.forename: P
authors.initials: P
authors.lastname: Jaïs
authors.forename: D C
authors.initials: DC
authors.lastname: Shah
authors.forename: M
authors.initials: M
authors.lastname: Hocini
authors.forename: J T
authors.initials: JT
authors.lastname: Peng
authors.forename: I
authors.initials: I
authors.lastname: Deisenhofer
authors.forename: J
authors.initials: J
authors.lastname: Clémenty
authors.forename: M
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013696:Temperature; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D016896:Treatment Outcome; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology / Q000601:surgery*