Key result
Ablation lesions with His and atrial EGMs on the distal bipole and no ventricular EGM on the proximal bipole resulted in complete atrioventricular block in 72% of cases versus 38% overall (P=0.001).
Why the study?
Does mapping the AVN utilizing electrograms on both proximal and distal bipoles improve the likelihood of complete atrioventricular block in patients undergoing AVN ablation?
Observational (n=441)
Does mapping the AVN utilizing electrograms on both proximal and distal bipoles improve the likelihood of complete atrioventricular block in patients undergoing AVN ablation?
Combining proximal and distal bipole EGM characteristics during AVN ablation significantly improves the likelihood of achieving complete atrioventricular block and avoids right bundle branch injury.
May improve AVN ablation success with EGM mapping; leaves open need for randomized confirmation.
BACKGROUND: Atrioventricular node (AVN) ablation is effective for rate control in atrial fibrillation. This may require multiple radiofrequency applications to achieve complete atrioventricular block (CAB). In this retrospective study, we tested the hypothesis that mapping the AVN utilizing electrograms (EGMs) on both proximal and distal bipoles of the mapping catheter may improve the likelihood of CAB. METHODS: Lesion characteristics and EGM components on the proximal and distal bipoles of the ablation catheter in first-time AVN ablation procedures were analyzed. Outcomes of each lesion, including presence of CAB, acute recurrence of AVN conduction, new-onset right bundle branch block (RBBB), and junctional escape rhythm, were analyzed. Multivariate binary logistic regression analysis was performed to identify EGM characteristics that independently predicted the outcomes of interest. Lesions with these EGM characteristics were then identified and their outcomes compared with the whole cohort. RESULTS: A total of 441 ablation lesions were analyzed. EGM characteristics that independently predicted outcomes were the presence of His and atrial EGMs on the distal bipole and the absence of ventricular EGM on the proximal bipole. Among the 25 lesions with all these characteristics, 18 (72%) resulted in CAB compared to the overall cohort rate of 38% (P = 0.001). There was no new-onset RBBB. The likelihood of acute recurrent AVN conduction and junctional escape rhythm were similar. CONCLUSION: Combining proximal and distal bipole EGM characteristics of the ablation catheter can improve the accuracy of AVN localization during AVN ablation and avoid right bundle branch injury.
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Yeo et al. (2013) conducted an observational in Atrial fibrillation requiring atrioventricular node ablation (n=441). Presence of His and atrial EGMs on the distal bipole and absence of ventricular EGM on the proximal bipole vs. Overall cohort was evaluated on Complete atrioventricular block (CAB) (p=0.001). Ablation lesions with His and atrial EGMs on the distal bipole and no ventricular EGM on the proximal bipole resulted in complete atrioventricular block in 72% of cases versus 38% overall (P=0.001).
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