TABLE 3.
Electrophysiological Characteristics of the Ablation Procedure
| First Author (Ref. #), Year | Nonfluoroscopic System | Isoprenaline Provocation | RF Catheter | Acute Success | Definition of Success | Junctional Rhythm | Abrupt Response | Fluoroscopic Time | Complications |
|---|---|---|---|---|---|---|---|---|---|
| Lee et al. (3), 1995 | No | Yes | Standard 4 or 10 mm | 16 (100%) | SN ablation: a reduction in HR >50% of the tachycardia HR with a junctional escape rhythm SN modification: at least a 25% reduction in the HR under the same conditions of catecholamine infusion with either retention of the normal P-wave axis in frontal and horizontal planes or transient low atrial escape rhythm |
4 (25%) | NA | 3.6 ± 0.8 min (ICE guided); 58.5 ± 8.4 min (non–ICE guided) | 1 case of right diaphragmatic paralysis 1 case of SVC syndrome |
| Callans et al. (5), 1999 | Yes | Yes | Standard 4 or 8 mm | 8 (80%) | 1) an abrupt decrease (30 beats/min) in sinus rate during RF lesion delivery; 2) the sudden appearance of superiorly directed P-wave morphology (negative P-wave in lead III); 3) the persistence of these features despite infusion of isoproterenol for at least 30 min after the delivery of the final RF lesion | NA | 11 (84.6%) | NA | Nonprocedure-related complications |
| Man et al. (4), 2000 | No | Yes | Standard 4 mm | 22 (75.8%) | Reduction of the baseline sinus rate to 90 beats/min, and ≥20% reduction in the sinus rate during infusion of isoproterenol | 8 (27.6%) | 9 (41%) | 59 ± 37 min | 1 case of PN paralysis (persisted for 41 months) |
| Marrouche et al. (16), 2002 | Yes | Yes | Standard 4 mm | NA | Ablation was terminated if the HR dropped to <120 beats/min during isoproterenol infusion at 2 mg/min alone or in combination with aminophylline infusion | NA | NA | 21 ± 6 min | 1 case of SVC syndrome |
| Bonhomme et al. (13), 2003 | Yes | Yes | Standard 4 mm | 2 (100%) | The ablation strategy described in the studies by Lee et al. and Marrouche et al. was used | 0 | NA | 29 min | 2 cases of pericarditis |
| Takemoto et al. (15), 2011 | Yes | Yes | Standard 4 mm | 6 (100%) | Breakout sites observed during HR of >100 beats/min moved completely from the tall P-wave zone to the normal P-wave zone with and without the intravenous administration of isoproterenol in accordance with the abolishment of the tall P-waves on the 12-lead ECG during the RF energy delivery | NA | NA | NA | Nonprocedure-related complications |
| Frankel et al. (18), 2012 | Yes (75.8%); no (24.2%) |
Yes | Open-irrigated 3.5 mm and irrigated ablation 4 mm tip | NA | Decrease of >25% in resting HR, with a shift of P-wave morphology from positive to flat or negative in leads III and aVF | NA | NA | NA | 1 procedure was complicated by AV fistula. 1 retroperitoneal bleed |
| Jacobson et al. (17), 2014 | Yes | Yes | Open-irrigated 3.5 mm | 5 (100%) | 25% reduction in sinus HR and inversion of P-wave axis | 4 (80%) | NA | 3 cases of pericarditis. 1 case of RV puncture during pericardial access |
|
| Ibarra-Cortez et al. (14), 2015 | Yes | Yes | Open-irrigated 3.5 mm | 13 (100%) | A decrease in HR ≥20% from baseline off isoproterenol and an associated change in the P-wave morphology in lead III and aVF from a positive to a flat or negative deflection | 11 (84.6%) | NA | 22.56 ± 15.6 min | 1 case of cardiac tamponade |
| Total | — | — | — | 72/81 (88.9%) | — | 27/65 (41.6%) | NA | 38.76 ± 28.41 min | 13 (8.5%) |
AV = arteriovenous; ICE = intracardiac echocardiography; PN = phrenic nerve; RF = radiofrequency; RV = right ventricular; SN = sinus node; SVC = superior vena cava; other abbreviations as in Table 1.