What does this research mean for the field?

The electroanatomically estimated length of the slow pathway in atrioventricular nodal reentrant tachycardia is significantly correlated with the distance to the successful ablation site, demonstrating that ablating anteriorly is not a prerequisite for procedural success. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 12, 2013Heart and VesselsOpen Access

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrioventricular nodal reentrant tachycardia (AVNRT) (n=46). Intervention: Electroanatomic mapping system (EAMS)-guided radiofrequency ablation. Primary outcome: Correlation between length of slow pathway (SP-L) and distance to successful ablation site (SucABL-L) (R2 = 0.5243, p=<0.0001).

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Key result

Electroanatomically estimated length of the slow pathway in atrioventricular nodal reentrant tachycardia was significantly correlated with the distance to the successful ablation site.

Study Design

Type

Observational (n=46)

Multicenter

Structured PICO

Population

46 patients (26 women, 20 men) with slow-fast atrioventricular nodal reentrant tachycardia (AVNRT), mean age 64.6 ± 11.6 years.

Intervention

Electroanatomic mapping system (EAMS)-guided radiofrequency (RF) ablation of the slow pathway using a stepwise approach.

Outcome

Correlation among the length of the slow pathway (SP-L), the length of Koch's triangle (Koch-L), the conduction time over the slow pathway (SP-T), and the distance between His bundle and the site of successful ablation (SucABL-L).surrogate

Main Result

Effect estimate: R2 = 0.5243

p-value: p=<0.0001

Electroanatomic mapping reveals that the length of the slow pathway varies individually and correlates with Koch's triangle size, suggesting that ablating anteriorly away from the posterior end is not a prerequisite for successful AVNRT ablation.

Limitations

Lack of evidence for an anatomic correlation between the sites of induction of junctional rhythm and the most atrial end of the slow pathway.
Heating effect might not reach the posterior end if the slow pathway is in a deep endocardial layer.
Junctional activity might not occur during RF application at the site of successful ablation in some cases.
The AH interval during tachycardia was measured in only one-third of the population.
The atrial electrogram at the sites of successful ablation was not mapped during the tachycardia.
The effects of output, duration of RF energy, and tissue temperature on the development of junctional rhythm were not evaluated.
No evidence of an anatomic correlation between the sites of induction of junctional rhythm and the most atrial end of the SP
The AH interval during tachycardia was measured in only one-third of the population whose tachycardia was inducible at baseline
Did not map the atrial electrogram during the tachycardia at the sites of successful ablation
Did not evaluate the output, duration of RF energy, and tissue temperature on the development of junctional rhythm during RF application

Discussion

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Implication

Individual slow pathway variation may guide AVNRT ablation targets; leaves open whether mapping improves outcomes over standard approaches.

Cite This Study

Irie et al. (2013) conducted an observational in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=46). Electroanatomic mapping system (EAMS)-guided radiofrequency ablation was evaluated on Correlation between length of slow pathway (SP-L) and distance to successful ablation site (SucABL-L) (R2 = 0.5243, p=<0.0001). Electroanatomically estimated length of the slow pathway in atrioventricular nodal reentrant tachycardia was significantly correlated with the distance to the successful ablation site.

synapsesocial.com/papers/6a1275ebc031bb6829a6a4ed https://doi.org/10.1007/s00380-013-0424-0

Topics

AF ablation outcomes

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Implication

Individual slow pathway variation may guide AVNRT ablation targets; leaves open whether mapping improves outcomes over standard approaches.

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider