Should fast pathway ablation be reconsidered in typical atrioventricular nodal re‐entrant tachycardia?
Autor: | Patrick J. Tchou, Newton B. Wiggins, Niraj Varma, Walid Saliba, Stephen Tuohy, Eric L Kiehl, Kevin Trulock, Daniel J. Cantillon, Thomas Dresing, Christine Tanaka, Khaldoun G. Tarakji, Maki Ono, Mohammed Bassiouny |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male Tachycardia medicine.medical_specialty Time Factors medicine.medical_treatment Action Potentials Catheter ablation 030204 cardiovascular system & hematology Electrocardiography 03 medical and health sciences Electrophysiology study 0302 clinical medicine Heart Rate Recurrence Risk Factors Physiology (medical) Internal medicine medicine Humans Tachycardia Atrioventricular Nodal Reentry Sinus rhythm 030212 general & internal medicine PR interval Atrioventricular Block Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Middle Aged Ablation medicine.disease Treatment Outcome Atrioventricular Node Catheter Ablation Cardiology Female Supraventricular tachycardia medicine.symptom Electrophysiologic Techniques Cardiac Cardiology and Cardiovascular Medicine business Atrioventricular block |
Zdroj: | Journal of Cardiovascular Electrophysiology. 30:1569-1577 |
ISSN: | 1540-8167 1045-3873 |
Popis: | Introduction Atrioventricular nodal re-entry tachycardia (AVNRT) is the most common, regular narrow-complex tachycardia. The established treatment is catheter ablation of the AV nodal slow pathway (SP). However, in a select group of patients with long PR intervals in sinus rhythm, SP ablation can lead to AV block due to the absence of robust anterograde conduction through the fast pathway (FP). This report aims to demonstrate that AV nodal FP ablation is a reasonable approach in patients with AVNRT and poor or absent anterograde FP conduction. Methods and results Standard electrophysiology study techniques were used in the electrophysiology laboratory. Catheter ablations were performed using radiofrequency energy. Mapping of intracardiac activation was performed with electroanatomical mapping systems. Outcomes were assessed acutely during the procedure and during routine clinical follow-up. Six patients with first-degree AV block and recurrent AVNRT who underwent ablation of their tachycardia at our institution are presented. One patient underwent ablation of AV nodal SP resulting in high-degree AV block necessitating pacemaker implantation. The remaining five patients underwent ablation of the AV nodal FP guided by electroanatomical mapping of the earliest atrial activation in tachycardia. These five had successful treatment of the tachycardia with preservation of anterograde AV nodal conduction. Mapping and ablation approach to eliminate retrograde FP conduction are described. Conclusion In select patients with AVNRT and poor anterograde FP conduction, retrograde FP ablation is reasonable and is less likely to result in AV block and pacemaker dependency. |
Databáze: | OpenAIRE |
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