Ablation of the atrioventricular junction

Abstract

Atrioventricular junctional ablation is an attempt to interrupt conduction from the atrium to the ventricle using radiofrequency energy. The objective is to ablate the compact atrioventricular node as high as possible, leaving a stable ventricular escape rhythm. The compact node is identified in part by its relation to His recordings and partly through the known anatomy. In our series of 115 consecutive patients, atrioventricular block was achieved from the right side in 96% of patients and the remainder had the atrioventricular node ablated from the left side. Long-term success, i.e. complete heart block, was achieved in all patients. Complications in this and other series are rare, but there remains concern about sudden death in these patients. (Europace 1999; 1: 26-29)

JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

“…The most common procedure involves direct ablation of the AV junction. 685 A pacing catheter is placed in the right ventricle to prepare for AV block. Immediately after creating the AV block, a permanent pacemaker is implanted.…”

Electroanatomic mapping in atrioventricular junction ablation during sinus rhythm for tachycardia‐bradycardia syndrome with persistent left superior vena cava

“…Complete AV junction ablation can be accomplished by targeting either the compact AV node or the His bundle, although the compact AV node is usually favored 2,3 . In sinus rhythm, ablation of the compact AV node is guided by an AV electrogram ratio of 1:1 and a small, early His electrogram.…”

“…She was doing well at her last follow-up outpatient clinic appointment, which was 13 weeks after catheter ablation. Her lower rate limit was decreased from 80 to 70 bpm.Complete AV junction ablation can be accomplished by targeting either the compact AV node or the His bundle, although the compact AV node is usually favored 2,3. In sinus rhythm, ablation of the compact AV node is guided by an AV electrogram ratio of 1:1 and a small, early His electrogram.…”

Hybrid Therapy in the Management of Atrial Fibrillation

“…Ablation of a compact AV node, being currently a standard radio-frequency ablation procedure, has almost a 100% success rate, has a short duration and presents very few complications [50, 51]. Patients have permanent pacemakers implanted which are programmed to rate responsive VVI,R mode (adjusting rate according to the physiologic needs of the patient).…”