Temperature monitoring during radiofrequency catheter ablation is useful but requires specialized equipment that is not generally available. Previous studies have shown that impedance characteristically decreases as the result of heating at the electrode-tissue interface. The purpose of the current study was to determine if impedance changes during radiofrequency current application could be used to estimate endocardial temperature in patients undergoing catheter ablation. Data from 43 patients treated with a thermistor ablation catheter were retrospectively analyzed. The slope of the initial 2 seconds of the impedance curve and subsequent changes in impedance were incorporated into an equation for estimation of temperature in real-time. The accuracy of this equation was assessed by prospectively comparing the calculated and measured temperatures in 19 patients. Of the 88% of energy applications that were suitable for analysis, the average difference between calculated and measured temperatures was 5.2 +/- 5.6 degrees C. The average error was < 10 degrees C in 89% of applications. The results of this study suggest that impedance measurements can be used to quantify tissue temperature in real-time during radiofrequency catheter ablation. This method is sufficiently accurate to allow titration of power output to produce temperatures in the useful range (50-80 degrees C) while avoiding excessive heating (> 90 degrees C).