Key result
Empirical slow pathway ablation yields low symptom recurrence, especially with pre-procedural ECG documentation at ~2%.
Why the study?
The study was designed to assess the long-term efficacy and safety of empirical slow pathway ablation in pediatric and adult patients, particularly those without dual AV nodal physiology.
Does empirical slow pathway ablation prevent symptom recurrence in patients with suspected AV nodal reentrant tachycardia?
Cohort (n=115)
No
Does empirical slow pathway ablation prevent symptom recurrence in patients with suspected AV nodal reentrant tachycardia?
Empirical slow pathway ablation is safe and effective for preventing symptom recurrence in patients with suspected AVNRT, even in the absence of dual AV nodal physiology.
Supports consideration of empirical ablation in suspected AVNRT; leaves open confirmation via randomized trials.
Background: The aim of this study was to assess long-term efficacy and safety of empirical slow pathway (ESP) ablation in pediatric and adult patients with a special interest in patients without dual AV nodal physiology (DAVNP). Methods: A retrospective single-center review of patients who underwent ESP ablation between December 2014 and September 2022 was performed. Follow-up included telephone communication, letter questionnaire and outpatient presentation. Recurrence was based on typical symptoms. Results: 115 patients aged 6–81 years (median age 36.3 years, 59.1% female; 26 pts < 18 years) were included. A typical history was present in all patients (100%), an ECG documentation of narrow complex tachycardia in 97 patients (84%). Patients were divided into three groups: Group 1 without DAVNP (n = 23), Group 2 with AH jump (n = 30) and Group 3 with AH jump and at least one AV nodal echo beat (n = 62). No permanent AV block was observed. During a median follow-up of 23.6 ± 22.7 months, symptom recurrence occurred in 7/115 patients (6.1%) with no significant difference between the groups (p = 0.73, log-rank test). Symptom recurrence occurred significantly more often in patients without (5/18 patients; 27%) as compared to patients with ECG documentation (2/97 patients; 2.1%; p = 0.025). No correlation between age and success rate was found (p > 0.1). Conclusions: ESP ablation is effective and safe in patients with non-inducible AVNRT. Overall, recurrence of symptoms during long-term follow-up is low, even if no DAVNP is present. Tachycardia documentation before the EP study leads to a significantly lower recurrence rate following ESP ablation.
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Telishevska et al. (2023) conducted a cohort in Suspected AV Nodal Reentrant Tachycardia (AVNRT) (n=115). Empirical slow pathway (ESP) ablation was evaluated on Symptom recurrence (complete elimination of clinical symptoms without documentation of AVNRT recurrence). Empirical slow pathway ablation resulted in a low long-term symptom recurrence rate of 6.1%, with significantly lower recurrence in patients with pre-procedural ECG documentation (2.1% vs 27%, p=0.025).
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