Circulation, Vol 85, 1675-1688, Copyright © 1992 by American Heart Association
GN Kay, AE Epstein, SM Dailey and VJ Plumb
BACKGROUND. The circuit of atrioventricular (AV) nodal reentrant
tachycardia may include perinodal atrial myocardium. Furthermore, in
patients with dual AV nodal pathways, the atrial insertion of the slow
pathway is likely to be located near the ostium of the coronary sinus,
caudal to the expected location of the AV node. The present study was
designed to evaluate the safety and efficacy of selective catheter ablation
of the slow pathway using radiofrequency energy applied along the tricuspid
annulus near the coronary sinus ostium as definitive therapy for AV nodal
reentrant tachycardia. METHODS AND RESULTS. Among 34 consecutive patients
who were prospectively enrolled in the study, the slow pathway was
selectively ablated in 30, and the fast pathway was ablated in four.
Antegrade conduction over the fast pathway remained intact in all 30
patients after successful selective slow pathway ablation. There was no
statistically significant change in the atrio-His interval (68.5 +/- 21.8
msec before and 69.6 +/- 23.9 msec after ablation) or AV Wenckebach rate
(167 +/- 27 beats per minute before and 178 +/- 50 beats per minute after
ablation) after selective ablation of the slow pathway. However, the
antegrade effective refractory period of the fast pathway decreased from
348 +/- 94 msec before ablation to 309 +/- 79 msec after selective slow
pathway ablation (p = 0.005). Retrograde conduction remained intact in 26
of 30 patients after selective ablation of the slow pathway. The retrograde
refractory period of the ventriculo-atrial conduction system was 285 +/- 55
msec before and 280 +/- 52 msec after slow pathway ablation in patients
with intact retrograde conduction (p = NS). There were three complications
in two patients, including an episode of pulmonary edema and the
development of spontaneous AV Wenckebach block during sleep in one patient
after slow pathway ablation and the late development of complete AV block
in another patient after fast pathway ablation. Over a mean follow-up
period of 322 +/- 73 days, AV nodal reentrant tachycardia recurred in three
patients, all of whom were successfully treated in a second ablation
session. CONCLUSIONS. Radiofrequency ablation of the slow AV pathway is
highly effective and is associated with a low rate of complications.
ARTICLES
Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia. Evidence for involvement of perinodal myocardium within the reentrant circuit
Department of Medicine, University of Alabama, Birmingham 35294.
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