Key result
Age >70 linked to ~8-fold higher complete heart block risk after AVNRT ablation alongside prolonged PR.
Why the study?
Catheter ablation for symptomatic AVNRT carries a risk of heart block requiring a pacemaker, but clinical predictors of this complication remain to be determined.
Observational (n=1,708)
Yes
Age >70, baseline PR ≥190 ms, and lack of electroanatomic mapping are independent predictors of complete heart block requiring a pacemaker after AVNRT ablation.
May warrant caution in elderly patients with prolonged PR during AVNRT ablation; leaves open whether mapping reduces risk in prospective data.
BACKGROUND: Catheter ablation is considered the first-line treatment of symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). It has been associated with a risk of heart block (HB) requiring a pacemaker. This study aims to determine potential clinical predictors of complete heart block as a result AVNRT ablation. METHODS: Consecutive patients undergoing catheter ablation for AVNRT from January 2001 to June 2019 at two tertiary hospitals were included. We defined ablation-related HB as the unscheduled implantation of pacemaker within a month of the index procedure. Use of electroanatomic mapping (EAM), operator experience, inpatient status, age, sex, fluoroscopy time, baseline PR interval, and baseline HV interval was included in univariate and multivariate models to predict HB post ablation. RESULTS: In 1708 patients (56.4 ± 17.0 years, 61% females), acute procedural success was 97.1%. The overall incidence of HB was 1.3%. Multivariate analysis showed that age more than 70 (odds ratio [OR] 7.907, p ≤ .001, confidence interval [CI] 2.759-22.666), baseline PR ≥ 190 ms (OR 2.867, p = .026, CI 1.135-7.239) and no use of EAM (OR 0.306, p = .037, CI 0.101-0.032) were independent predictors of HB. CONCLUSION: Although the incidence of HB post AVNRT ablation is generally low, patients can be further stratified using three simple predictors.
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Makker et al. (2021) conducted an observational in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=1,708). Catheter ablation was evaluated on Complete heart block requiring unscheduled pacemaker implantation within a month of ablation (OR 7.907, 95% CI 2.759-22.666, p=≤.001). Age >70 years (OR 7.907; 95% CI 2.759-22.666), baseline PR ≥190 ms, and no use of electroanatomic mapping independently predicted complete heart block after AVNRT ablation.
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