Slow pathway radiofrequency ablation at medial or anterior locations significantly reduced AVNRT recurrences compared to historical inferoposterior approaches (1% vs 13%, P=0.004).
Cohort (n=160)
Does slow pathway radiofrequency ablation at medial or anterior locations reduce AVNRT recurrences compared to inferoposterior and anteromedial locations in patients with symptomatic AVNRT?
Performing slow pathway radiofrequency ablation at medial or anterior locations significantly reduces AVNRT recurrences compared to inferoposterior locations.
Absolute Event Rate: 1% vs 13%
p-value: p=0.004
AIMS: The site of successful ablation of the slow atrioventricular (AV) nodal pathway may be located in the posteroseptal or midseptal area. We have previously shown that the site of successful radiofrequency (RF) ablation of the slow pathway, rather than residual slow pathway conduction correlates with AV nodal re-entrant tachycardia (AVNRT) recurrences, with more recurrences noted in inferoposterior (to the coronary sinus os) locations. Accordingly, we have since modified our approach, and in a consecutive series of 105 patients we have performed slow pathway RF ablation exclusively at medial or anterior locations, with the objective of prospectively examining the recurrence rate of AVNRT incurred with this approach. METHODS AND RESULTS: The study included 40 men and 65 women, aged 42 +/- 18 years, having RF ablation for symptomatic AVNRT exclusively in anterior to the coronary sinus os locations. A combined anatomical and electrophysiological approach to slow pathway ablation was employed. This series of patients was compared with the previous series of 55 patients (historical group) with AVNRT undergoing RF ablation at both inferoposterior and anteromedial locations. The mean cycle length of the induced AVNRT was 329 +/- 48 ms. RF ablation was successful in all patients (100%). A mean of 7 +/- 6 lesions were applied. Persistent jump or echo beats were noted in 48 patients (46%). The procedure lasted for 2.1 +/- 1.0 h. Fluoroscopy time was 23 +/- 14 min. Procedures were complicated by heart block in two patients (1.9%). Over 26 +/- 19 months, there has been only one recurrence of AVNRT (1%). The historical group had similar age (37 +/- 18 years), gender (17 men/38 women), AVNRT cycle length (340 +/- 60 ms), number of RF lesions (9 +/- 6), or residual slow pathway conduction (42%), but longer fluoroscopy time (41 +/- 25 min) and procedure duration (4 +/- 1 h), and a significantly higher recurrence rate (seven patients/13%) (P=0.004) at a much shorter follow-up period of 12 +/- 8 months. CONCLUSION: AVNRT recurrences are rare (1%) when slow pathway RF ablation is performed in medial or anterior locations at the tricuspid annulus, rather than in inferoposterior sites, whereby a higher (13%) recurrence rate has been previously noted.
Antonis S. Manolis (Mon,) conducted a cohort in AV nodal re-entrant tachycardia (AVNRT) (n=160). Radiofrequency ablation of the slow pathway at medial or anterior locations vs. Radiofrequency ablation at inferoposterior and anteromedial locations (historical group) was evaluated on AVNRT recurrence (p=0.004). Slow pathway radiofrequency ablation at medial or anterior locations significantly reduced AVNRT recurrences compared to historical inferoposterior approaches (1% vs 13%, P=0.004).