Identifying an appropriate endpoint for cryoablation in children with atrioventricular nodal reentrant tachycardia: Is residual slow pathway conduction associated with recurrence?
| Autor: | William R. Goodyer, Kimberly DeBruler, Scott R. Ceresnak, Anthony Trela, Anne M. Dubin, Nina Zook, Kara S. Motonaga, Henry Chubb |
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| Rok vydání: | 2020 |
| Předmět: |
Tachycardia
Male medicine.medical_specialty Adolescent Radiofrequency ablation Slow pathway Endpoint Determination medicine.medical_treatment Cryosurgery law.invention law Recurrence Physiology (medical) Internal medicine medicine Humans Tachycardia Atrioventricular Nodal Reentry Retrospective Studies Univariate analysis business.industry Hazard ratio Isoproterenol Cryoablation Ablation Confidence interval Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart rhythm. 19(2) |
| ISSN: | 1556-3871 |
| Popis: | Background Cryoablation is increasingly used to treat atrioventricular nodal reentrant tachycardia (AVNRT) due to its safety profile. However, cryoablation may have higher recurrence than radiofrequency ablation (RFA), and the optimal procedural endpoint remains undefined. Objective The purpose of this study was to identify the association of cryoablation procedural endpoints with postprocedural AVNRT recurrence. Methods We performed a single-center, retrospective analysis of pediatric patients following successful first-time cryoablation for AVNRT between January 1, 2011, and December 31, 2019. Preablation inducibility of AVNRT was recorded. Procedural endpoints, including slow pathway (SP) conduction (presence of jump or echo beats) with and without isoproterenol, were identified. Recurrence was established from clinical notes and/or direct patient contact. Results Of 256 patients, 147 (57%) were assessed on isoproterenol precryoablation, and 171 (47%) were assessed on isoproterenol postcryoablation. Mean cryolesion time was 2586 ± 1434 seconds. Following ablation, 104 (41%) had some evidence of residual SP conduction. With median follow-up time of 1.9 [0.7–3.7] years, recurrence occurred in 14 patients (5%). Complete elimination of SP conduction (with and without isoproterenol) had a hazard ratio for recurrence of 1.26 (95% confidence interval [CI] 0.42–3.8; P = .68) on univariate analysis and 1.39 (95% CI 0.36–5.4; P = .63) on multivariate analysis (including demographics, ablation time, 8-mm cryocatheter, and baseline inducibility). Conclusion The observed AVNRT recurrence rate after cryoablation was comparable to that of RFA. The presence of residual SP conduction was not associated with recurrence. This suggests that jump or single echo beat may be an acceptable endpoint in AVNRT cryoablation. |
| Databáze: | OpenAIRE |
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