Rapid Atrial Pacing: A Useful Technique During Slow Pathway Ablation

Liberman, Leonardo; Hordof, Allan J.; Pass, Robert H.

doi:10.1111/j.1540-8159.2007.00653.x

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…Rapid atrial pacing is commonly practiced during EPS and provides useful information regarding AV node status 14 . A critical parameter obtained from atrial pacing is WCL, defined as the atrial pacing period at which AV nodal conduction degenerates to Wenckebach Rhythm 15 .…”

Section: Discussionmentioning

confidence: 99%

Wenckebach cycle length: A novel predictor for AV block in AVNRT patients treated with ablation

Chatzidou

Kontogiannis

Georgiopoulos

et al. 2021

Pacing Clinical Electrophis

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Background Radiofrequency catheter ablation remains the most effective management option for atrioventricular nodal reentry tachycardia (AVNRT). The risk of atrioventricular (AV) block requiring permanent pacemaker is substantial, but, currently, a reliable method to predict this complication is lacking. Methods The electrophysiologic studies (EPS) and baseline characteristics of patients who underwent catheter ablation for the treatment of AVNRT were retrospectively analyzed to investigate predisposing factors for AV block after treatment. Patients were followed for AV block at one month and one year after hospital discharge. Results Among 784 patients treated with catheter ablation for AVNRT between 1999 to 2019, 15 developed AV block. Patients with AV block were older (p = .001). Among the recorded EPS parameters, patients with AV block had significantly higher Atrial His interval (120 vs. 110 ms, p = .049), Wenckebach cycle length (WCL) (400 vs. 353 ms, p < .001) and tachycardia CL (400 vs. 387 ms, P = .01) during the ablation compared to their peers without AV block. Additionally, only WCL (OR = 1.1, 95% CI 1.02‐1.19, p = .017) remained significant after adjustment for age, gender, ERP, AH interval, and HR. This association was confirmed by comparing patients with (n = 15) and without (n = 15) AV block using propensity score‐matching. A WCL≥400ms was associated with a 4‐fold higher incidence of AV block (4.79% vs. 1.25%). Conclusion Increased pre‐procedural WCL was associated with a high risk for AV block after catheter ablation treatment for AVNRT. These findings suggest that this readily available EPS‐derived parameter may be a novel marker of risk for severe complications in these patients.

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Section: Discussionmentioning

confidence: 99%

Wenckebach cycle length: A novel predictor for AV block in AVNRT patients treated with ablation

Chatzidou

Kontogiannis

Georgiopoulos

et al. 2021

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…[2] SP modification, rather than the fast pathway method, is now the preferred approach to ablate AVNRT because of the lower incidence of complications. [3] The AV node is a relatively large structure and the belief is that the fast pathway alone is sufficient to maintain the AV conduction for the remainder of the patient's life, after blocking the SP.…”

Section: Discussionmentioning

confidence: 99%

Atrioventricular nodal re-entrant tachycardia ablation: Unusual function of slow pathway

2011

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Slow pathway (SP) ablation is an acceptable, standard method for atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. The exact role of SP in the human heart and the possible negative implications of SP ablation are unknown. The current case report describes an unusual, brief, functional heart block, following radiofrequency ablation of the SP. Our findings highlight the peculiar property of the SP in maintaining conduction over an atrioventricular (AV) node, in circumstances of extreme autonomic imbalance. SP can be ablated without major conduction problems for AVNRT. Careful pre-ablation evaluation of the AV conduction pattern may assist in predicting occurrences of this type of heart block.

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“…2,4 Retrograde conduction block during JR or development of rapid JR are significant predictors of AVB in patients undergoing SP ablation. Previous studies have suggested several strategies to avoid AVB including transient discontinuation of energy delivery with the development of JR, and multiple repeat ablations with progressively longer durations ≤30 s. 8 Another method proposed by Liberman et al 9 argued that rapid atrial pacing during ablation could be used to ensure intact anterograde conduction. However, JR that is slightly faster than the pacing CL may be difficult to identify in this setting and retrograde conduction cannot be assessed during JR.…”

Section: Discussionmentioning

confidence: 99%

Atrioventricular Block During Slow Pathway Ablation

Chen

Shehata

et al. 2015

Circ: Arrhythmia and Electrophysiology

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A trioventricular nodal reentrant tachycardia (AVNRT) is the most common regular supraventricular tachycardia. Slow pathway (SP) modification has evolved as the first-line treatment, 1,2 with acute success rates of 95% to 98%. A sensitive sign for success of the procedure is observation of accelerated junctional rhythm (JR) during ablation. 3 The serious complication of AV block (AVB) can occur, and affects ≈1% to 2.3% of patients during or after catheter ablation procedures. 2,4 Some studies have demonstrated that loss of VA conduction during radiofrequency application predicts impending AVB during ablation. 5,6 From this illustrative series of cases assembled from 4 large tertiary care centers during a period of 3 years, we analyze some possible reasons for occurrence of AVB, and suggest methods to prevent this complication during SP modification procedures. Editor's Perspective see p 745Case 1A 58-year-old woman with a history of paroxysmal supraventricular tachycardia was refractory to medical therapy and referred for ablation. The baseline AH and HV intervals were 80 and 50 ms, respectively. Atrial pacing at 600 ms demonstrated fast pathway conduction and jump to SP conduction with a single echo beat ( Figure 1A, left). A narrow QRS tachycardia with the same retrograde conduction sequence was induced during isoproterenol infusion, by atrial programmed stimulation ( Figure 1A, right), which was diagnosed as AVNRT with cycle length (CL) of 380 ms, AH of 280 ms, HV of 50 ms, and VA of 50ms. No further pacing maneuvers were performed during tachycardia and SP modification was performed guided by fluoroscopy with a power setting of 30 W, temperature 60°C and total duration of 35 s. During radiofrequency delivery, JR with 1:1 retrograde conduction was observed during radiofrequency application with a CL between 500 and 600 ms, and 4 beats of sinus rhythm with relatively normal PR interval ( Figure 1B). Complete AVB occurred following 1 beat of prolonged PR interval after terminating radiofrequency. Programmed ventricular stimulation (S1S2, 500/320 ms) showed nondecremental retrograde conduction with a short conduction time and similar retrograde atrial activation compared with tachycardia suggestive that a concealed septal accessory pathway was present ( Figure 1C). The patient had implantation of a pacemaker 7 days after the ablation procedure without recovery of AV nodal conduction. Case 2A 65-year-old man with a history of paroxysmal supraventricular tachycardia was referred for a catheter ablation procedure. During the procedure, baseline intervals AH and HV were 85 and 52 ms, respectively. The anterograde effective refractory period of the fast pathway and SP was 600/320 ms and 600/280 ms, respectively. Atrial programmed stimulation induced narrow QRS tachycardia with CL of 290 ms, AH of 245 ms, HV of 45 ms, and VA of 0 ms, which was diagnosed as typical AVNRT (Figure 2A). SP modification was performed with a combined anatomic and electrogram mapping approach with power setting 30 W, temperature 60°C and tot...

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Rapid Atrial Pacing: A Useful Technique During Slow Pathway Ablation

Abstract: Rapid atrial pacing during radiofrequency catheter ablation of the slow pathway is a safe alternative approach to ensure normal AVN function.

Cited by 10 publications

References 20 publications

Wenckebach cycle length: A novel predictor for AV block in AVNRT patients treated with ablation

Wenckebach cycle length: A novel predictor for AV block in AVNRT patients treated with ablation

Atrioventricular nodal re-entrant tachycardia ablation: Unusual function of slow pathway

Atrioventricular Block During Slow Pathway Ablation

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