Difference of Clinical Course after Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia between Younger and Older Patients: Atrial Vulnerability Predicts New Onset of Atrial Fibrillation

Abstract

Background The aim of this study was to compare the long-term procedural outcomes, the stability of atrioventricular conduction, and the new onset of atrial fibrillation (AF), after ablation of atrioventricular nodal reentrant tachycardia (AVNRT). Methods and ResultsConsecutive patients with AVNRT (n=109), who underwent slow-pathway ablation, were divided into two groups based on the median age of the studied patients: the younger group aged <55 years and the older group aged !55 years. During a mean follow-up period of 60.6 months, the rate of change in the PR interval from before ablation to follow-up was significantly greater in older patients compared with younger patients. However, there was no delayed-onset high-degree AV block during follow-up in either group. No patients in the younger group suffered from persistent AF, whereas persistent AF occurred in 5/54 (9.3%) older patients. Multivariate Cox analysis revealed that atrial vulnerability, with induction of AF during the electrophysiological study, was the only predictor of the development of AF (Hazard ratio: 13.9, 95% confidence interval: 1.62-119.2, p<0.01). Conclusion Slow-pathway ablation of AVNRT is a reliable strategy even in older patients. However, physicians should consider regular long-term follow-up of older patients with atrial vulnerability, in order to assess the subsequent development of AF.

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years

“…History of AF and increased atrial vulnerability were moreover found to be risk factors of later AF. Arimoto et al [ 21 ] also reported that physicians should consider regular long-term follow-up of older patients with atrial vulnerability in order to assess the subsequent development of AF. Importantly, in patients without AF history or AF during follow-up in the present series, 17 patients (1.1%) in those aged <70 and 9 (3.4%) in those aged 70 or older experienced a stroke during follow-up ( Table 3 ).…”

Recurrences of symptoms after AV node re-entrant tachycardia ablation: A clinical arrhythmia risk score to assess putative underlying cause

“…A substantial risk of AF has been reported in patients with AVNRT [20][21][22][23][24][25], reaching as high as 12% during a mean 1-year follow-up [22]. In a recent study by Ozcan et al [26] AF was seen in 27% of 1573 patients, and AF was seen in 19.6% of patients before ablation of the SVT and 9.07% after ablation of an SVT aside from AF In a previous study by our group [20] performed in patients recruited in the 1980's and 1990's, we reported that patients with AVNRT had a 5% risk of AF.…”

“…Although long-term AVNRT recurrence rate is low, the risk of persistent inappropriate sinus tachycardia [18,19] and atrial fibrillation (AF) or other atrial arrhythmias is increased after AVNRT ablation [20][21][22][23][24][25]. In untreated patients with AVNRT, AF has been shown to occur in as high as 12% of patients within one year of follow-up [22].…”