Temperature-controlled slow pathway ablation for treatment of atrioventricular nodal reentrant tachycardia using a combined anatomical and electrogram guided strategy

Abstract

The combined approach for slow pathway ablation is highly effective, requiring a low number of radiofrequency pulses. Long atrial activation time seems to be the most powerful predictor of success. Similar catheter tip temperature levels during successful and unsuccessful radiofrequency applications indicate that suboptimal selection of target sites rather than ineffective heating due to poor catheter tissue coupling is responsible for unsuccessful energy delivery.

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

“…1 Complete elimination of the slow pathway is not necessary for long-term symptomatic relief of the arrhythmia; the most widely accepted endpoint for acute success of the procedure is noninducibility of the arrhythmia. 1,2 Routinely after slow-pathway ablation, attempts at reinduction of arrhythmia are performed, with or without isoproterenol or other provocative medications.…”

“…1 Complete elimination of the slow pathway is not necessary for long-term symptomatic relief of the arrhythmia; the most widely accepted endpoint for acute success of the procedure is noninducibility of the arrhythmia. 1,2 Routinely after slow-pathway ablation, attempts at reinduction of arrhythmia are performed, with or without isoproterenol or other provocative medications. 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).…”

Risk of development of delayed atrioventricular block after slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a pre-existing prolonged PR interval

“…Radiofrequency catheter ablation is considered to be the first-line therapy for patients with symptomatic atrioventricular nodal reentrant tachycardia [15,16] with a very low incidence of complications after slow pathway modification [1][2][3][4][5][6][7][8][9][10] . However, procedural success and safety have not been well defined in atrioventricular nodal reentrant tachycardia patients with a prolonged PR interval.…”

“…Slow pathway modification for cure of atrioventricular nodal reentrant tachycardia (AVNRT) has been reported to be highly effective and safe, with an incidence of atrioventricular block of <1·5% in patients with atrioventricular nodal reentrant tachycardia and a normal PR interval [1][2][3][4][5][6][7][8][9][10] . However, in patients with atrioventricular nodal reentrant tachycardia and a pre-existing prolonged PR interval, only sparse data are available concerning the incidence and risk factors of delayed development of atrioventricular block during long-term follow-up after successful slow pathway modification [11][12][13] .…”

Efficacy and Safety of Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in the Elderly

“…The incidence of AVNRT in very elderly patients has become of increased clinical relevance due the demographic change with an increased life expectancy of the general population. Radiofrequency (RF) catheter ablation is the first line therapy in patients with AVNRT and is associated with a high success and a low complication rate 1–3 . There are only a small number of studies available investigating the incidence of the induction of an atrioventricular (AV) block by slow‐pathway ablation in elderly patients 4,5 .…”