New Research Paper
Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia: A Contemporary, Multicenter Study

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Abstract

Objectives

This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT).

Background

Published data are conflicting.

Methods

The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT.

Results

Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively).

Conclusions

Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.

Key Words

ablation
atrioventricular
atypical
nodal
re-entrant
slow pathway
tachycardia

Abbreviations and Acronyms

AV
atrioventricular
AVNRT
atrioventricular nodal re-entrant tachycardia
CI
confidence interval
IQR
interquartile range
OR
odds ratio
RF
radiofrequency
VA
ventriculoatrial

Cited by (0)

Dr. Zografos has received research support from AstraZeneca. Dr. Muthalaly has received research support from Avant Mutual and Monash Health. Dr. John has received lecture honoraria (modest) for educational programs from Abbott Medical and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.