Transvenous Ablation with High Frequency Energy for Atrioventricular Junctional (AV Nodal) Reentrant Tachycardia

Abstract

We performed transcatheter AV junction ablation with high frequency energy in four patients with AV nodal reentrant tachycardia where extensive trials of several antiarrhythmic drugs failed to prevent further recurrences of tachycardia. Initially high frequency catheter ablation induced complete AV block in all patients. A recuperation of AV 1:1 conduction followed some time later, persisting in follow-up. No complications have been encountered in either the acute phase or the follow-up (from 6 to 8 months; mean +/- SD: 8.7 +/- 2.5 months). The electrophysiological study was carried out 6 weeks following ablation, and all patients showed AV 1:1 conduction. No dual nodal pathway was encountered and no tachycardia could be triggered. With refinement of the method, the potential application of high frequency energy to interrupt intranodal or perinodal connections responsible for reentrant supraventricular tachycardia or to retard AV nodal conduction appears promising.

Catheter Ablation with Radiofrequency Energy: Biophysical Aspects and Clinical Applications

“…[38][39][40][41] Two different approaches to radiofrequency catheter modification of AV nodal reentrant tachycardia are now being used. These techniques have been able to eliminate reentry while still preserving antegrade conduction.…”

“…Initial experience with radiofrequency ablation to produce variable degrees of AV block in animals suggested that the safety and titratibility of this energy source would make it well suited for treatment of AV nodal reentry.^^"^^ Early reports on small series of patients confirmed that radiofrequency catheter ablation could be used to eliminate reentry with preservation of conduction. [38][39][40][41] Two different approaches to radiofrequency catheter modification of AV nodal reentrant tachycardia are now being used. The first technique developed was one where lesions are applied slightly anterior and proximal to the site of the maximal His electrogram'^''* ( Fig.…”

Closed Chest Radiofrequency Ablation of the Sinoatrial Node in Dogs

“…Sinus /unction was previously studied in terms of cycle lengtii, recovery time and atrial activation pattern by catheter mapping. SeveraJ discharges (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) were applied for variable periods of time (maximum 1 minutej. Sinus tachycardia and/or sinus arrest during ablation conjirmed correct catheter position.…”