Key result
Atrial vulnerability during electrophysiological study strongly predicted the new onset of atrial fibrillation after slow-pathway ablation of atrioventricular nodal reentrant tachycardia (HR 13.9).
Why the study?
Does older age increase the risk of new onset atrial fibrillation or atrioventricular conduction abnormalities in patients undergoing slow-pathway ablation for AVNRT?
Cohort (n=109)
No
Does older age increase the risk of new onset atrial fibrillation or atrioventricular conduction abnormalities in patients undergoing slow-pathway ablation for AVNRT?
Effect estimate: HR 13.9 (95% CI 1.62-119.2)
p-value: p=<0.01
Slow-pathway ablation for AVNRT is safe in older patients, but those with atrial vulnerability during EP study are at high risk for developing persistent AF and require long-term monitoring.
Atrial vulnerability warrants targeted post-AVNRT ablation AF monitoring; leaves open whether routine EP testing improves outcomes in older patients.
BACKGROUND: The aim of this study was to compare the long-term procedural outcomes, the stability of atrioventricular conduction, and the new onset of atrial fibrillation (AF), after ablation of atrioventricular nodal reentrant tachycardia (AVNRT). METHODS AND RESULTS: Consecutive patients with AVNRT (n=109), who underwent slow-pathway ablation, were divided into two groups based on the median age of the studied patients: the younger group aged <55 years and the older group aged ≥55 years. During a mean follow-up period of 60.6 months, the rate of change in the PR interval from before ablation to follow-up was significantly greater in older patients compared with younger patients. However, there was no delayed-onset high-degree AV block during follow-up in either group. No patients in the younger group suffered from persistent AF, whereas persistent AF occurred in 5/54 (9.3%) older patients. Multivariate Cox analysis revealed that atrial vulnerability, with induction of AF during the electrophysiological study, was the only predictor of the development of AF (Hazard ratio: 13.9, 95% confidence interval: 1.62-119.2, p<0.01). CONCLUSION: Slow-pathway ablation of AVNRT is a reliable strategy even in older patients. However, physicians should consider regular long-term follow-up of older patients with atrial vulnerability, in order to assess the subsequent development of AF.
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Arimoto et al. (2011) conducted a cohort in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=109). Slow-pathway catheter ablation vs. Younger (<55 years) vs Older (≥55 years) patients was evaluated on New onset of atrial fibrillation (predicted by atrial vulnerability) (HR 13.9, 95% CI 1.62-119.2, p=<0.01). Atrial vulnerability during electrophysiological study strongly predicted the new onset of atrial fibrillation after slow-pathway ablation of atrioventricular nodal reentrant tachycardia (HR 13.9).
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