Clinical efficacy of radiofrequency current in the treatment of patients with atrioventricular node reentrant tachycardia

Abstract

Eight women (mean age 41 years, range 24 to 62) with drug-resistant atrioventricular (AV) node reentrant tachycardia underwent radiofrequency catheter ablation. Radiofrequency energy was delivered in a unipolar mode with use of a back paddle as the anode placed between the two scapulae. The total applied energy was 2,233 +/- 1,919 J. The AH interval increased from 87 +/- 13 to 113 +/- 17 ms (p less than 0.05) and the PQ interval increased from 141 +/- 15 to 169 +/- 34 ms (p less than 0.05). The anterograde Wenckebach cycle length increased from 300 +/- 41 to 320 +/- 42 ms (p less than 0.05). Retrograde conduction was abolished in five patients. Atrioventricular node tachycardia was still inducible in three patients. During a follow-up period of 9 +/- 3 months, four patients remained clinically asymptomatic without drug therapy and four patients had recurrent symptoms. Three of the latter responded to previously unsuccessful antiarrhythmic drugs and the fourth patient underwent surgical cure for persistence of tachycardia. Right bundle branch block occurred in five patients; it was permanent in four and transient in one. In conclusion, radiofrequency catheter ablation represents a valuable but still investigational therapy in patients with drug-refractory AV node reentrant tachycardia.

Atrioventricular nodal reentry. Clinical, electrophysiological, and therapeutic considerations.

“…AV nodal reentry was successfully controlled by ablation of either the fast or slow pathway in six of nine cases. The use of radiofrequency as the energy source in patients with AV nodal reentrant tachycardia was first reported by Goy et al 70 Most of the earlier experience with radiofrequency modification of the AV node deals with ablation of the fast pathway. The successful outcome was noted in 50-91% of the cases, but complete AV block occurred in 2-8%.…”

Role of Compact Node and Posterior Extension in Direction‐Dependent Changes in Atrioventricular Nodal Function in Rabbit

“…When it does, the same ablation interrupts anterograde and retrograde slow pathways, thus suggesting use of the same substrate in both directions 12 , 16–21 . Retrograde conduction often ceases after fast pathway ablation 13 , 22–26 . This interruption and the prevalence of septal breakthrough during retrograde conduction 20 indicate that the fast pathway plays a major role in retrograde AV nodal function 27 .…”

Selective Radiofrequency Catheter Ablation of the Slow Pathway for Common and Uncommon Atrioventricular Nodal Reentrant Tachycardia.

“…[17][18][19] Uncommon AVNRT occurs much less frequently than common AVNRT, and it also has more variations in ECG manifestations and mechanisms. 19 23) Radiofrequency catheter ablation targeting the slow pathway has been shown to be highly effective and safe as a curative therapeutic modality in the slow-fast form of common AVNRT, [3][4][5][6][7][8][9][10][11][12][13][14] however, its utility in uncommon AVNRT has not been fully investigated. In this study, the efficacy and safety of radiofrequency catheter ablation for uncommon AVNRT was compared with common AVNRT.…”

“…Permanent cure of AVNRT with the preservation of AVN conduction was initially achieved by surgical ablation of perinodal tissue.1,2 The catheter ablation technique which selectively ablates the fast or slow pathway was then developed, and selective slow pathway ablation is now the dominant non-pharmacologic curative therapy for AVNRT. [3][4][5][6][7][8][9][10][11][12][13][14] It has been well accepted that there are two types of AVNRT, common and uncommon. Slow-fast form common AVNRT with the slow pathway as an antegrade limb of reentry circuit and the fast pathway as a retrograde limb is characterized on ECG by a long PR interval, 15,16) while the fast-slow form or slow-slow form of uncommon AVNRT with the fast or slow pathway as an antegrade limb and the slow pathway as a retrograde limb is characterized on ECG in general by a long RP interval.…”