Left septal slow pathway ablation for AVNRT resulted in a 0% recurrence rate at 3 months when used primarily, compared to 6.7% when used after failed right-sided ablation (P=1.000).
Cohort (n=26)
Does left septal slow pathway ablation effectively and safely treat AVNRT in patients with or without prior failed right septal ablation?
Left septal ablation at the anatomic site of the left inferior nodal extension is an effective and safe alternative for AVNRT, particularly when right posterior septal ablation is ineffective.
Absolute Event Rate: 0% vs 6.7%
p-value: p=1.000
Background: Immunohistochemistry studies suggest that the anatomic substrate of the slow pathway in atrioventricular nodal reentrant tachycardia (AVNRT) is the left inferior nodal extension. We hypothesized that slow pathway ablation from the left septum is an effective alternative to right-sided ablation. Methods and Results: We analyzed our databases of AVNRT in search of cases that had used slow pathway ablation from the left septum because of failure of right septal ablation, and then prospectively subjected consenting patients to a left septal–only procedure. Of 1342 patients subjected to right septal slow pathway ablation for AVNRT, 15 patients, 11 with typical and 4 with atypical AVNRT, had a left septal approach after unsuccessful right-sided ablation (R+L group). Eleven patients were subjected to a left septal–only approach for slow pathway ablation without a previous right septal attempt (L group). Fluoroscopy times in the R+L and L groups were 30.5 (21.0–44.0) and 20.0 (17.0–25.0) minutes, respectively ( P =0.061), and radiofrequency current delivery times were 11.3 (5.0–19.1) and 10.0 (7.0–12.0) minutes, respectively ( P =0.897). There was no need for additional ablation lesions at other anatomic sites in either group, and no cases of atrioventricular block were encountered. Recurrence rates of the arrhythmia for the R+L and L groups were 6.7% and 0%, respectively, in the 3 months after ablation ( P =1.000). Conclusions: Left septal ablation at the anatomic site of the left inferior nodal extension is an alternative for ablation of both typical and atypical AVNRT when ablation at the right posterior septum is ineffective.
Katritsis et al. (Thu,) conducted a cohort in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=26). Left septal slow pathway ablation vs. Right septal ablation followed by left septal ablation was evaluated on Recurrence rates of the arrhythmia in the 3 months after ablation (p=1.000). Left septal slow pathway ablation for AVNRT resulted in a 0% recurrence rate at 3 months when used primarily, compared to 6.7% when used after failed right-sided ablation (P=1.000).