Delayed recurrence of atrioventricular block after radiofrequency ablation of atrioventricular node reentry: A word of caution

“…Radiofrequency (RF) catheter ablation has become the treatment of choice for may supraventricular and ventricular arrhythmias 1,2 . Among the factors contributing to this widespread acceptance are its efficacy and safety, chiefly the latter, because a significant subset of patients undergoing RF ablation is composed of young people without structural heart disease 1–7 . However, it has been observed that the effects of RF energy on myocardium might not be limited to the duration of energy delivery.…”

Section: Introductionmentioning

confidence: 99%

“…However, it has been observed that the effects of RF energy on myocardium might not be limited to the duration of energy delivery. Delayed effects may occur for as long as hours to months after the procedure as manifest by late disappearance of conduction through an atrioventricular accessory pathway or late atrioventricular block following ablation of an atrioventricular nodal reentrant tachycardia 3–9 . The reasons for delayed RF effects are unclear, but extension of the lesion beyond the area of acute coagulative necrosis is believed to play a central role 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Combined Therapy with Steroids and Antioxidants Prevents Ultrastructural Damage Surrounding Chronic Radiofrequency Lesions

Fenelon

Franco

Mora

et al. 2004

Pacing Clinical Electrophis

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We evaluated the effects of combined therapy with anti-inflammatory and antioxidant drugs on the healing of radiofrequency (RF) lesions (70 degrees C, 60 s) produced in the right atrium and each ventricle of 21 adult dogs. Three groups were studied: acute (n= 7, sacrificed 1 hour after RF); control (n = 7, sacrificed 54 +/- 29 days after RF); and dogs (n = 7, sacrificed 32 +/- 5 days after RF) receiving combined therapy with allopurinol (400 mg p.o. 24 and 2 hours before RF); verapamil (200 microg/kg i.v. 15 min before and after RF); hydrocortisone (10 mg/kg i.v. after RF) and prednisone (20 mg p.o. for 29 days). Atrial (n = 37) and ventricular (n = 70) lesion dimensions were determined and 21 right ventricular apex lesions (1 per dog) were selected for light and electron microscopy analysis. Histological and ultrastructural (US) characteristics in three zones extending from the visible lesion border, A (0-3 mm); B (3-6 mm); and C (6-9 mm), were assessed. In chronic groups, atrial and ventricular lesion dimensions were similar, but delayed scar formation was noted in treated animals. Acutely and at follow-up, significant US abnormalities occurred in zones A and B and chronic lesions exhibited type I collagen proliferation. In Zone A, the extent of US injury and collagen proliferation was significantly less in treated dogs. Further, Zone B was normal in 5/7 (71%) treated dogs and in 0/7 (0%) controls. Zone C was essentially normal in all groups. Combined therapy with steroids, verapamil, and allopurinol is effective in limiting US damage surrounding chronic RF lesions.

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“…However, several rare cases have been reported in which the patient developed an AV block late after the procedure and subsequently required a permanent pacemaker implantation. 4,5 Here, we describe a 22-year-old woman with a first-degree AV block who developed a complete AV block 1 week after RF ablation for the treatment of the uncommon form of AVNRT (slow/slow). Her complete AV block persisted for another week, and she then recovered.…”

mentioning

confidence: 99%

Transient Complete Atrioventricular Block Occurring 1 Week After Radiofrequency Ablation for the Treatment of Atrioventricular Nodal Re-Entrant Tachycardia.

Takahashi¹,

Mitsuhashi²,

Hashimoto³

et al. 2002

Circ J

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trioventricular (AV) block following radiofrequency ablation for the treatment of AV nodal re-entrant tachycardia (AVNRT) is a rare but serious complication of this procedure. [1][2][3] The AV block usually occurs during or immediately following the application of radiofrequency (RF) energy, and is transient. However, several rare cases have been reported in which the patient developed an AV block late after the procedure and subsequently required a permanent pacemaker implantation. 4,5 Here, we describe a 22-year-old woman with a first-degree AV block who developed a complete AV block 1 week after RF ablation for the treatment of the uncommon form of AVNRT (slow/slow). Her complete AV block persisted for another week, and she then recovered. Case ReportA 22-year-old woman was referred to the Jichi Medical Hospital (Tochigi, Japan) for consideration of RF ablation of supraventricular tachycardia. An electrocardiogram (ECG) showed that she had a first-degree AV block, which she had had from the age of 12 years. Since age 19, she had developed fast palpitations with dyspnea and her symptoms had increased. An ECG during sinus rhythm showed a first-degree AV block with a pulse rate interval of 0.28 s (Fig 1A). An ECG during symptoms showed a narrow QRS complex tachycardia with a deeply inverted P wave in II at 130 beats/min (Fig 1B). Results of her physical examination, laboratory analysis, chest X-ray, and echocardiography were normal, indicating that the patient has no other cardiovascular disease except for first-degree AV block. Circulation Journal Vol.66, November 2002An electrophysiologic study and RF ablation were performed under mild sedation after first obtaining the patient's informed consent. Catheters were positioned in the high right atrium, coronary sinus and right ventricular apex, and across the tricuspid valve to record the His bundle potential. At baseline (A -A interval: 825 ms), atrio-His (A-H) and His-ventricular (H-V) intervals were 225 ms and 30 ms, respectively. Using the extrastimulus technique, dual AV nodal physiology was demonstrated with a 140 ms jump in A-H intervals for a 10 ms decrease in coupling interval (S1-S1: 750 ms; S1-S2: 260 ms) (Fig 2A). At a pacing cycle length of 750 ms, the antegrade effective refractory period (ERP) of the AV node was 220 ms. The site of earliest atrial activation potential during ventricular pacing was the coronary sinus ostium (VA: 375 ms; Fig 2B] Atrioventricular (AV) block following radiofrequency (RF) ablation for the treatment of AV nodal re-entrant tachycardia (AVNRT) is a rare but serious complication of this procedure. Almost all such cases occur during or immediately after radiofrequencey (RF) energy application, followed by prompt recovery. The present report describes a 22-year-old woman with first-degree AV block on electrocardiography, who developed complete AV block 1 week after RF ablation for the treatment of the uncommon form of AVNRT (slow/slow). The patient's complete AV block persisted for another 1 week before she recovered. (Circ J ...

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Delayed recurrence of atrioventricular block after radiofrequency ablation of atrioventricular node reentry: A word of caution

Cited by 9 publications

References 3 publications

Atrio-ventricular conduction following radiofrequency ablation for atrio-ventricular node reentry tachycardia in children

Atrio-ventricular conduction following radiofrequency ablation for atrio-ventricular node reentry tachycardia in children

Combined Therapy with Steroids and Antioxidants Prevents Ultrastructural Damage Surrounding Chronic Radiofrequency Lesions

Transient Complete Atrioventricular Block Occurring 1 Week After Radiofrequency Ablation for the Treatment of Atrioventricular Nodal Re-Entrant Tachycardia.

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