Key result
In patients with a residual jump after AVNRT cryoablation, a post-procedural prolongation of the AV nodal effective refractory period >30 ms was associated with a significantly lower recurrence rate compared to a prolongation ≤30 ms (18.8% vs 60.8%, HR 0.25).
Why the study?
Does post-procedural AV nodal ERP prolongation >30 ms prevent AVNRT recurrence in patients with a residual jump after successful slow pathway cryoablation?
Cohort (n=303)
Yes
Does post-procedural AV nodal ERP prolongation >30 ms prevent AVNRT recurrence in patients with a residual jump after successful slow pathway cryoablation?
In patients undergoing cryoablation for AVNRT, a residual slow pathway jump can be tolerated without a high risk of recurrence if the post-procedural AV nodal effective refractory period is prolonged by more than 30 ms.
Answers are grounded in this paper and cite their sources.
May support tolerating residual jumps if AV nodal ERP prolongs >30 ms; leaves open prospective validation in AVNRT cryoablation.
PURPOSE: A residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump. METHODS: We analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter. Success was defined as AVNRT non-inducibility. Patients with no baseline elicitable jump, no inducible AVNRT, and transient first atrioventricular (AV) block at the last site were excluded. RESULTS: From 371 patients who underwent cryoablation from May 2002 to March 2011, 303 fulfilled the entry criteria (mean age, 41 ± 16; 222 women). Baseline AV nodal effective refractory period (ERP) was 272 ± 57 ms, postprocedural 331 ± 64 (P < 0.001), and the mean of the difference (Δ ERP) 60 ± 41. At the end of the procedure, 64 patients (21 %) had a residual jump, of whom 22 with a single echo. At 12 months follow-up, the actuarial recurrence-free rate was 70.3 % in patients with a residual jump and 86 % in those without (P = 0.01). In patients with a jump, only Δ AV nodal ERP was correlated with recurrence (37 ± 41 vs. 68 ± 47 ms; P < 0.04) while a single echo was not. The actuarial rate of recurrence was 60.8 % in patients with a Δ AV nodal ERP ≤ 30 ms and 18.8 % in those with a Δ AV nodal ERP >30 ms (P < 0.01). CONCLUSIONS: Suppression of slow pathway conduction is the optimal endpoint for AVNRT cryoablation. A residual jump can be tolerated if AV nodal ERP postcryoablation is prolonged >30 ms.
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Tonet et al. (2012) conducted a cohort in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=303). Post-procedural prolongation of AV nodal effective refractory period >30 ms vs. Prolongation ≤30 ms was evaluated on AVNRT recurrence at 12 months in patients with a residual jump (HR 0.25, 95% CI 0.09-0.69, p=<0.01). In patients with a residual jump after AVNRT cryoablation, a post-procedural prolongation of the AV nodal effective refractory period >30 ms was associated with a significantly lower recurrence rate compared to a prolongation ≤30 ms (18.8% vs 60.8%, HR 0.25).
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