Key result
Initial low-power slow pathway ablation achieves acute AVNRT success in ~84% of patients without AV block.
Why the study?
Catheter ablation is the definitive treatment for typical AVNRT, but AV block requiring permanent pacemaker implantation remains a major safety concern, motivating evaluation of a low-power (20 W) slow pathway ablation strategy.
Does an initial low-power (20 W) slow pathway radiofrequency ablation strategy with selective power escalation achieve high procedural efficacy while avoiding permanent atrioventricular block in patients with typical AVNRT?
Cohort (n=203)
Open-label
Yes
Does an initial low-power (20 W) slow pathway radiofrequency ablation strategy with selective power escalation achieve high procedural efficacy while avoiding permanent atrioventricular block in patients with typical AVNRT?
Initiating slow pathway catheter ablation at 20 W with selective power escalation eliminates typical AVNRT in 83.7% of patients without escalation (99.5% overall acute success) with zero cases of permanent AV block, while identifying younger age and higher baseline heart rate as independent predictors for needing >20 W.
Supports initial 20 W AVNRT ablation with zero permanent block; leaves open randomized confirmation of predictors and safety.
Background Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia. Although catheter ablation is the definitive treatment, atrioventricular (AV) block requiring permanent pacemaker implantation remains a major safety concern. Objective To evaluate the efficacy and safety of a low-power (20 W) slow pathway ablation strategy for typical AVNRT. Methods In this prospective multicenter study, 203 consecutive patients (mean age 54.4 ± 17.3 years; 59.6% women) underwent slow pathway ablation initiated at 20 W, with power escalation as needed. Variables associated with requiring higher power were analyzed using univariable and multivariable logistic regression. Results Initial success at 20 W was achieved in 170 patients (83.7%); 33 patients (16.3%) required higher power, with an overall acute success rate of 99.5%. Compared with patients who achieved success at 20 W, those requiring higher power were younger and had higher pre-ablation heart rates. On univariable analysis, younger age [odds ratio [OR] 0.66 per 10-year increase, 95% confidence interval [CI] 0.54–0.83; p < 0.001] and higher pre-ablation heart rate (OR 1.88 per 10-bpm increase, 95% CI 1.30–2.73; p < 0.001) were associated with the need for higher power. Transient AV block occurred in 1.9% of patients, and no cases of permanent AV block (0%, 95% CI 0%–1.8%) or pacemaker implantation were observed. During 18.3 ± 4.1 months of follow-up, recurrence occurred in two patients (0.9%). Conclusion An initial 20 W ablation strategy provides high efficacy with a favorable safety profile and no permanent AV block observed in this cohort. Younger age and a higher baseline heart rate predicted the need for power escalation, supporting an initial low-power approach for AVNRT ablation.
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Jung et al. (2026) conducted a cohort in Typical atrioventricular nodal reentrant tachycardia (AVNRT) (n=203). Initial low-power (20 W) slow pathway radiofrequency catheter ablation with selective power escalation was evaluated on Acute procedural success (slow pathway ablation or modification without inducible AVNRT) and initial success at 20 W. Initial low-power (20 W) slow pathway ablation achieved success in 83.7% of AVNRT patients (99.5% overall with escalation), with 0% permanent AV block and 0.9% recurrence over 18.3 months.
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