Key result
AVNRT patients with concomitant CTI-dependent atrial flutter had significantly more continuous AV node function curves than those without (OR 7.55; 95% CI 3.70-16.7; P<0.001).
Why the study?
What are the electrophysiological differences in AVNRT patients with versus without concomitant CTI-dependent atrial flutter, and does slow pathway ablation affect atrial flutter inducibility?
Observational (n=1,063)
What are the electrophysiological differences in AVNRT patients with versus without concomitant CTI-dependent atrial flutter, and does slow pathway ablation affect atrial flutter inducibility?
AVNRT patients with concomitant CTI-dependent atrial flutter frequently exhibit continuous AV node function curves, and slow pathway ablation alone eliminates atrial flutter inducibility in over 40% of these patients, suggesting a shared slow conduction isthmus.
Continuous AV node curves were associated with concomitant CTI flutter in AVNRT; leaves open whether this reflects a shared isthmus modifiable by slow pathway ablation.
AIMS: The detailed electrophysiological characteristics of patients with both atrioventricular nodal re-entrant tachycardia (AVNRT) and atrial flutter (AFL) have not been clarified. This study investigated the related electrophysiological differences in a large series of patients undergoing radiofrequency catheter ablation of AVNRT. METHODS AND RESULTS: A total of 1063 clinically documented AVNRT patients underwent catheter ablation were enrolled. Before the slow pathway (SP) ablation, 61 patients (5.7%) had inducible sustained cavotricuspid isthmus (CTI)-dependent AFL (Group 1), and the others (94.3%) without inducible sustained CTI-dependent AFL were defined as Group 2. The electrophysiological characteristics of these two groups and effect of the SP ablation on the inducibility of AFL were assessed. In Group 1, 36 patients (59%) had inducible/sustained AFL after the ablation of AVNRT and required a CTI ablation. The Group 1 patients had more AVNRT with continuous atrioventricular (AV) node function curves (P < 0.001, odds ratio = 7.55 [3.70-16.7], multivariate regression), and a younger age (P = 0.02, odds ratio = 1.02 [1.003-1.03], multivariate regression) than Group 2. The other characteristics were comparable between the two groups. The long-term follow-up (64.9 ± 34.9 months) revealed that the recurrence of AFL/atrial fibrillation was similar between the two groups (P > 0.05). CONCLUSION: Atrioventricular nodal re-entrant tachycardia patients with concomitant CTI-dependent AFL had more continuous AV node function curves. Forty-one per cent of these patients had non-inducible AFL after the SP ablation, indicating a slow conduction isthmus in the triangle of Koch area.
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Lin et al. (2015) conducted an observational in Atrioventricular nodal re-entrant tachycardia (AVNRT) (n=1,063). Slow pathway (SP) ablation vs. Patients without inducible sustained CTI-dependent AFL was evaluated on Continuous atrioventricular (AV) node function curves (OR 7.55, 95% CI 3.70-16.7, p=<0.001). AVNRT patients with concomitant CTI-dependent atrial flutter had significantly more continuous AV node function curves than those without (OR 7.55; 95% CI 3.70-16.7; P<0.001).
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