Key result
Initial low-power slow pathway ablation achieves ~84% acute success without permanent AV block.
Why the study?
Although catheter ablation is the definitive treatment for AVNRT, AV block requiring permanent pacemaker implantation remains a major safety concern, motivating evaluation of the efficacy and safety of a low-power (20 W) slow pathway ablation strategy.
Does a low-power (20 W) initial slow pathway catheter ablation strategy with selective power escalation achieve high procedural efficacy and prevent permanent AV block in patients with typical AVNRT?
Cohort (n=203)
Open-label
Yes
Does a low-power (20 W) initial slow pathway catheter ablation strategy with selective power escalation achieve high procedural efficacy and prevent permanent AV block in patients with typical AVNRT?
Initiating slow pathway catheter ablation at a low power of 20 W for typical AVNRT achieves a 83.7% initial success rate and 99.5% overall success rate with selective power escalation, resulting in zero cases of permanent AV block and a 0.9% recurrence rate over 18.3 months.
Supports initial low-power ablation for typical AVNRT with minimal AV block risk; leaves open randomized confirmation of efficacy.
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 univariate logistic regression. Results Initial success at 20 W was achieved in 170 patients (83.7%); 33 patients (16.3%) required higher power. Compared with patients who achieved success at 20 W, those requiring higher power were younger and had higher pre-ablation heart rates. On univariate 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 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 excellent safety and no permanent AV block. Younger age and a higher baseline heart rate predicted the need for power escalation, supporting a stepwise low-to-high 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). Low-power (20 W) slow pathway radiofrequency catheter ablation with selective power escalation was evaluated on Acute procedural success (at 20 W initial power and overall with escalation) and post-ablation recurrence, plus primary safety endpoint of permanent AV block. Low-power (20 W) initial slow pathway ablation achieved 83.7% initial success and 99.5% overall acute success with 0% permanent AV block and 0.9% recurrence over 18.3 months.
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