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
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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