Prediction of Clinical Recurrence of Atrioventricular-Nodal Reentrant Tachycardia (AVNRT) After Successful Slow Pathway Ablation

Abstract

Background Even after successful slow pathway (SP) ablation for atrioventricular-nodal reentrant tachycardia (AVNRT), there may be clinical recurrence in certain patients and it is clinically important to be able to predict that. Methods and ResultsIn 97 patients with common type AVNRT, the effective refractory period (ERP) of the fast pathway (FP), SP-ERP, and prolongation of the atrio-His (AH) interval (∆AH) at the time of jump-up phenomenon were investigated. In patients with residual SP, parameters were re-evaluated in a similar manner. SP was successfully ablated and AVNRT was not inducible in all the patients, but residual SP was observed in 54 of the 97 patients, and there was late clinical recurrence in 10 patients (10/54 patients with residual SP and 0/43 without residual SP, p=0.002). The changes in FP-ERP before and after ablation (∆FP-ERP) did not differ between recurrent and non-recurrent patients. Among the patients with residual SP, ∆SP-ERP did not differ between the groups. However, the changes in ∆AH before and after ablation (∆∆AH) were larger in non-recurrent (24±30 ms) than in the recurrent patients (4±7 ms, p=0.042). Conclusions In patients with AVNRT, the residual SP and changes in ∆AH after successful SP ablation might be useful indices of clinical recurrence. (Circ J 2004; 68: 558 -562)

Role of Isoproterenol in Predicting the Success of Catheter Ablation in Patients with Reproducibly Inducible Atrioventricular Nodal Reentrant Tachycardia

“…Consequently, the administration of isoproterenol after ablation can be avoided for this group, which constitutes a substantial portion (53%-86%) 12,15,17 of AVNRT patients.…”

“…Some physicians use isoproterenol after ablation regardless of its use before ablation (strategy 1), [3][4][5][6][7] whereas others use isoproterenol after ablation of AVNRT only when it had been necessary for arrhythmia induction before ablation (strategy 2). [8][9][10][11][12] However, the published data available for the comparison of these 2 strategies are inadequate. 13,14 In any event, the effectiveness of arrhythmia reproducibility in evaluating the success of AVNRT ablation has not been well defined: AVNRT inducibility is not reproducible in more than one third of cases, 15 and that failure of inducibility after ablation might sometimes indicate the absence of reproducibility, rather than the success of ablation.…”

“…[3][4][5][6][7] Others assume that the infusion of catecholamines is unnecessary after ablation, in cases wherein AVNRT is inducible in the basal state before ablation (strategy 2). [8][9][10][11][12] Neither group, however, has sufficiently examined the reproducibility of the arrhythmia, and both ignore the potential effect of reproducibility on the acute or longterm results of AVNRT ablation. [3][4][5][6][7][8][9][10][11][12] Weismuller and colleagues 13 studied reinduction of AVNRT after ablation in the basal state in comparison with reinduction during the infusion of orciprenaline as a β-adrenergic stimulator.…”

Inducibility of Atrial Flutter in Patients With Atrioventricular Nodal Reentrant Tachycardia

“…Slow pathway ablation was performed under electrophysiological guidance targeted to the "slow pathway potential". 13,14 The preset duration of each RF pulse was 60 s for slow pathway ablation and 120 s for other ablations. Induction of AVNRT was performed after each RF energy application.…”

Premature Atrial Complex With P'R Prolongation Indicates Multiple Atrioventricular Nodal Pathways

“…[1][2][3][4][5][6] Moreover, AV reciprocating tachycardia (AVRT) involving these multiple AVN pathways as the descending limb of the reentrant circuit has been observed. 7 Although these multiple AVN pathways have been diagnosed only by electrophysiologic study (EPS), ambulatory Holter recording, which is usually performed before invasive testing, may provide some relevant information.…”