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

Abstract

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.

A Minimally Invasive Approach for Cardiac Electrophysiology Studies in Mice

“…The literature regarding the indication of Wenckebach cycle length in preclinical studies is very limited. In a clinical study, increased Wenckebach Cannot pace atria; major damage to abdomen followed by diaphragm puncture; heart invisible; non-recovery; potential of pneumothorax and death cycle length was associated with a high risk for AV block [24]. In our case, shorter Wenckebach cycle length may indicate less sensitivity for AV block provocation by the minimally invasive approach.…”

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

“…preprocedural Wenkebach cycle length on electrophysiology study were also predictors of AVB. [28][29][30][31][32] A benefit with electroanatomical mapping (EAM) during CA was reported by Bergonti et al, with a lower incidence of late complications including AVB and pacemakers in EAM compared to conventional ablation under fluoroscopic guidance (0.5% vs. 3.4%, respectively). 14 The effects of energy source during CA on AVB is however, less certain.…”

“…Modifiable factors were mainly procedural‐related, with transient AVB during CA heralding 19.5‐fold increased odds of permanent AVB, 14 and 8.5‐fold increased odds of late pacemakers 13 . Precautionary measures to mitigate the risk of AVB during CA of AVNRT have been described, including the avoidance of the roof of the coronary sinus or the mid‐septal region during CA, limiting power delivery during RF application and observing for VA block or onset of fast junctional rhythm during CA, while prolonged AH or HV intervals at baseline and increased preprocedural Wenkebach cycle length on electrophysiology study were also predictors of AVB 28–32 . A benefit with electroanatomical mapping (EAM) during CA was reported by Bergonti et al, with a lower incidence of late complications including AVB and pacemakers in EAM compared to conventional ablation under fluoroscopic guidance (0.5% vs. 3.4%, respectively) 14 .…”

In Vivo Cardiac Electrophysiology in Mice: Determination of Atrial and Ventricular Arrhythmic Substrates

“…This Wenckebach paced cycle length is defined as the shortest cycle length at which AV conduction maintained a 1:1 relation during atrial pacing (Berul et al., 1996; Chatzidou et al., 2021). This protocol is performed to test AV nodal conduction properties.…”