Abstract
OBJECTIVE--To assess immediate and long term success of "fast" pathway catheter ablation with graded use of radiofrequency energy in patients with classic atrioventricular nodal reentrant tachycardia (AVNRT) and evaluate clinical, procedure related, and electrophysiological features affecting long term results. DESIGN--31 consecutive patients with classic AVNRT at electrophysiological study, who were candidates for radiofrequency ablation. Patients were followed for an average of 24 months after ablation. SETTING--All studies and ablations were performed in an electrophysiological laboratory under fluoroscopic guidance using standard electrophysiological techniques. INTERVENTION--Radiofrequency application was performed at the site of proximal His bundle electrogram with A:V ratio of > 1. It was started at 10 W with increment of 5 W to a maximum of 25 W at 60 s. With the onset of junctional rhythm, atrial pacing was begun in order to monitor the PR interval. Application was terminated prematurely with a non-conducted P wave, continued prolongation of the PR interval beyond 50% of the baseline, or a threefold rise in impedance. RESULTS--Successful ablation was possible in 30/31 patients (97%) with an average of seven applications (range 1-10). It was associated with significant prolongation of PR interval (P < 0.001) and AV Wenckebach cycle length (P = 0.01). Ventriculo-atrial conduction was abolished in 24/30 patients (82%) with successful ablation. Two patients developed transient complete heart block (3 and 12 min) and one persistent right branch block. Four patients had late recurrence. Presence of ventriculo-atrial block was the only electrophysiological index predictive of long term success (P = 0.01). CONCLUSIONS--Graded use of radiofrequency energy and atrial pacing to monitor PR interval decreases the risk of atrioventricular block in patients undergoing fast pathway ablation for AVNRT. Ventriculo-atrial block is predictive of long term success and should be a preferred end point for fast pathway ablation.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Chen S. A., Chiang C. E., Tsang W. P., Hsia C. P., Wang D. C., Yeh H. I., Ting C. T., Chuen W. C., Yang C. J., Cheng C. C. Selective radiofrequency catheter ablation of fast and slow pathways in 100 patients with atrioventricular nodal reentrant tachycardia. Am Heart J. 1993 Jan;125(1):1–10. doi: 10.1016/0002-8703(93)90050-j. [DOI] [PubMed] [Google Scholar]
- Denes P., Wu D., Dhingra R. C., Chuquimia R., Rosen K. M. Demonstration of dual A-V nodal pathways in patients with paroxysmal supraventricular tachycardia. Circulation. 1973 Sep;48(3):549–555. doi: 10.1161/01.cir.48.3.549. [DOI] [PubMed] [Google Scholar]
- Haissaguerre M., Gaita F., Fischer B., Commenges D., Montserrat P., d'Ivernois C., Lemetayer P., Warin J. F. Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation. 1992 Jun;85(6):2162–2175. doi: 10.1161/01.cir.85.6.2162. [DOI] [PubMed] [Google Scholar]
- Jackman W. M., Beckman K. J., McClelland J. H., Wang X., Friday K. J., Roman C. A., Moulton K. P., Twidale N., Hazlitt H. A., Prior M. I. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992 Jul 30;327(5):313–318. doi: 10.1056/NEJM199207303270504. [DOI] [PubMed] [Google Scholar]
- Jazayeri M. R., Hempe S. L., Sra J. S., Dhala A. A., Blanck Z., Deshpande S. S., Avitall B., Krum D. P., Gilbert C. J., Akhtar M. Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation. 1992 Apr;85(4):1318–1328. doi: 10.1161/01.cir.85.4.1318. [DOI] [PubMed] [Google Scholar]
- Kocovic D. Z., Harada T., Shea J. B., Soroff D., Friedman P. L. Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. Circulation. 1993 Oct;88(4 Pt 1):1671–1681. doi: 10.1161/01.cir.88.4.1671. [DOI] [PubMed] [Google Scholar]
- Langberg J. J., Leon A., Borganelli M., Kalbfleisch S. J., el-Atassi R., Calkins H., Morady F. A randomized, prospective comparison of anterior and posterior approaches to radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia. Circulation. 1993 May;87(5):1551–1556. doi: 10.1161/01.cir.87.5.1551. [DOI] [PubMed] [Google Scholar]
- Wu D., Denes P., Amat-y-Leon F., Dhingra R., Wyndham C. R., Bauernfeind R., Latif P., Rosen K. M. Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am J Cardiol. 1978 May 22;41(6):1045–1051. doi: 10.1016/0002-9149(78)90856-1. [DOI] [PubMed] [Google Scholar]