Late pacemaker implantation after atrioventricular nodal reentrant tachycardia ablation: A systematic review and meta‐analysis

Abstract

Introduction: Catheter ablation (CA) of atrioventricular nodal reentrant tachycardia (AVNRT) is associated with late pacemakers for AV block (AVB). We performed a systematic review and meta-analysis of the pooled incidence of late pacemakers for AVB after CA of AVNRT. Methods and Results: Relevant studies were identified from four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Trial Register) from inception to 2022. A random effects model was used to calculate the odds of late pacemakers in CA of AVNRT compared to atrioventricular reentrant tachycardia (AVRT). Of 533 articles screened, 13 were included in systematic review. CA for AVNRT was performed in 16 471 patients (mean age 54 ± 17 years, 63% females), of which 68 (0.4%) underwent pacemaker implantation for late AVB. Meta-analysis was performed in 5 of the 13 studies (mean follow-up duration 7 ± 4 years). Patients who underwent CA of AVNRT were older (58 ± 17 vs. 52 ± 20 years, p < .001), and more likely female (60% vs. 41%, p < .001) than AVRT. Pooled estimates of late pacemakers for AVB were higher in CA of AVNRT than AVRT (0.5% vs. 0.2%,

In‐vivo evaluation of catheter integrity with the use of a novel catheter torque tool

“…Rates of AV block have been reported at 1.6% in cases of ablation for ventricular arrhythmias 6 and there is an additional risk of long-term AV block after an ablation procedure with an almost twofold increase in patients with AVNRT. 7 The risk of complications is likely elevated in small patients, those with repaired and unrepaired congenital heart disease and certain substrates such as ventricular arrhythmias and AVNRT. Additionally, the impact of ablation-related complications is higher in smaller children, as they portend a decades-long dependence on permanent pacemaker therapy.…”

“…The rates of AV block in adults are higher and may be related to substrate and ischemia. Rates of AV block have been reported at 1.6% in cases of ablation for ventricular arrhythmias 6 and there is an additional risk of long‐term AV block after an ablation procedure with an almost twofold increase in patients with AVNRT 7 . The risk of complications is likely elevated in small patients, those with repaired and unrepaired congenital heart disease and certain substrates such as ventricular arrhythmias and AVNRT.…”

Atrioventricular nodal re‐entrant tachycardia: Are there unknown long‐term consequences of ablating the (incompletely) known?

“…In this issue of Journal of Cardiovascular Electrophysiology, Sim et al report a systematic review and meta-analysis of the pooled incidence of late pacemaker implantation (defined as >30 days) after catheter ablation of AVNRT. 9 Because sinus node dysfunction (SND) should be considered separately from AVB in the setting of AVNRT ablation, the authors specifically collected data in their pooled analysis based on pacemakers implanted for AVB only. Although the authors screened 533 articles, the majority were excluded and only 13 were selected for systematic review.…”