Key result
Transmural left atrial septal ablation eliminates AVNRT substrate after conventional right-sided ablation fails.
Why the study?
The reasons and mechanisms for failure of conventional right-sided ablation in AVNRT have not been adequately focused on or discussed in previous studies.
Case Report (n=1)
Left atrial ablation can effectively eliminate the substrate of AVNRT when conventional right-sided ablation fails, avoiding the high risk of AV block.
May warrant consideration in rare right-sided refractory AVNRT; leaves open need for prospective safety and efficacy data.
Key Teaching Points•Ablation in the left atrium is required when conventional right-sided ablation fails to eliminate typical or atypical atrioventricular nodal reentrant tachycardia (AVNRT) (∼1%).•Although left inferior extension of the slow pathway is considered a main reason for indispensable ablation of the inferior (posterior) part of the mitral annulus, the reasons and mechanisms for failure of right-sided ablation seem not to be focused on and may not have been adequately discussed in previous studies.•Even if a leftward extension of the slow pathway does not exist, left atrial ablation may be effective in eliminating the substrate of AVNRT to overcome the close proximity between the fast and slow pathways within the right atrium and the high risk of atrioventricular block. •Ablation in the left atrium is required when conventional right-sided ablation fails to eliminate typical or atypical atrioventricular nodal reentrant tachycardia (AVNRT) (∼1%).•Although left inferior extension of the slow pathway is considered a main reason for indispensable ablation of the inferior (posterior) part of the mitral annulus, the reasons and mechanisms for failure of right-sided ablation seem not to be focused on and may not have been adequately discussed in previous studies.•Even if a leftward extension of the slow pathway does not exist, left atrial ablation may be effective in eliminating the substrate of AVNRT to overcome the close proximity between the fast and slow pathways within the right atrium and the high risk of atrioventricular block.
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Yoshida et al. (2022) conducted a case report in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=1). Transmural ablation from the left atrial septum vs. Conventional right-sided ablation was evaluated on Elimination of AVNRT substrate. Transmural ablation from the left atrial septum successfully eliminated the AVNRT substrate in a patient after conventional right-sided ablation failed (a scenario occurring in ~1% of cases).
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