A randomized, prospective comparison of anterior and posterior approaches to radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia (original) (raw)
Related papers
American Heart Journal, 1996
Previous studies have reported only short-term (6 to 10 months) follow-up after ablation of atrioventricular (AV) nodal reentrant tachycardia by using the anterior approach. The objective of this study was to determine the long-term efficacy and safety of radiofrequency catheter ablation of AV nodal reentrant tachycardia with the anterior-approach method. In 56 patients (16 men and 40 women; mean [±SD] age, 44 ± 19 years) with symptomatic AV nodal reentrant tachycardia. In 53 patients, ablation was performed initially by using a standard 7F, 2 mm-tipped tripolar His bundle catheter when the large-tip electrode was not as available, and in the remaining 3 patients, ablation was performed with a 7F, 4 mm-tipped catheter. Ablation was successful in the short term in 53 (95%) patients after a median of 7 radiofrequency applications. Three (5%) patients developed complete AV block immediately after ablation. Six (11%) patients had recurrence of tachycardia within 3 months (n = 5) and 13 months (n = 1) after ablation. Repeated ablation resulted in successful outcome in 4 patients and in complete AV block in I patient; the other patient refused a repeated ablation attempt. A total of 51 patients was monitored for 36 ± 12 months (range, 25 to 72 months), and none had tachycardia recurrence or delayed AV block. In conclusion, our results show that the anterior approach to radiofrequency catheter ablation can be used successfully to treat patients with AV nodal reentrant tachycardia with a good long-term efficacy and safety. (Am Heart J 1996;132:125-9.) Atrioventricular (AV) nodal reentrant tachycardia is the most common form of paroxysmal supraventricular tachycardia and typically consists of anterograde conduction via a "slow" pathway and retrograde conduction via a "fast" pathway. Two anatomically different approaches have been developed for radiofrequency catheter ablation of AV
The American Journal of Cardiology, 1996
A trioventricular (AV) nodal reentrant tachycardia is one of the most common causes of paroxysmal supraventricular tachycardias. Typically, AV nodal reentrant tachycardia presents with a long PR interval, a short RP interval, and a PR/RP ratio ú1. It consists of anterograde conduction via the slow pathway and retrograde conduction via the fast pathway. 1 Several studies have demonstrated an atypical form of AV nodal reentrant tachycardia, characterized by a short PR interval, a long RP interval, and a PR/RP ratio õ1. 2-4 It is proposed that the fast pathway is used for anterograde conduction and the slow pathway for retrograde conduction in this form of tachycardia. However, information about the electrophysiologic characteristics, anatomic sites of retrograde slow pathways, and results of radiofrequency catheter ablation in patients with the fast-slow form of AV nodal reentrant tachycardia has not been clear. This study demonstrates the electrophysiologic characteristics, as well as the efficacy and safety of radiofrequency catheter ablation, in a large group of patients with the fast-slow form AV nodal reentrant tachycardia. j j j Among the 720 consecutive patients with AV nodal reentrant tachycardia, 25 patients (12 men and 13 women; age 46 { 18 years, range 20 to 70) who had the fast-slow form of AV nodal reentrant tachycardia only were designated as group I. Group II included 75 patients who had the slow-fast form of AV nodal reentrant tachycardia only; they were ageand sex-matched with group I patients. These patients had clinically documented supraventricular tachycardia, and they were referred to this institute for electrophysiologic study and radiofrequency catheter ablation. They were refractory or intolerant to 2 { 1 antiarrhythmic drugs.
Radiofrequency Catheter Ablation of AtypicalAtrioventricular Nodal Reentrant Tachycardia
Journal of Cardiovascular Electrophysiology, 1993
Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia. Introduction: Published reports of radiofrequency ablation of atypical atrioventricular nodal reentrant tacbycardia (AVNRT) have been limited. We present our experience in 10 consecutive patients with atypical AVNRT wbo underwent radiofrequency ablation of tbe "slow" AV nodal patbway.
American Journal of Cardiology, 1992
(AV) nodal reentry tachycardia (AVNRT) is characterized by anterograde activation over a slowly conducting pathway and by retrograde activation through a rapidly conducting pathway. Preliminary reports suggest that radiofrequency catheter modification can eliminate typical AVNRT while preserving anterograde conduction. Radiofrequency catheter modiication was used to treat 66 patients with typical AVNRT. After baseline electrophysiologic evaluation, the ablation catheter was positioned proximal and superlor to the site of maximal His deflection. Radiofrequency energy was applied until there was significant attenuation of retrograde conduction, and elimination of AVNRT inducibility. Eighty-one patients were successfully treated and form the basis of this report.
Advances in Interventional Cardiology, 2014
Introduction: Radiofrequency (RF) ablation of the slow pathway for treatment of atrioventricular nodal reentrant tachycardia (AVNRT) is conventionally performed during sinus rhythm. Aim: To evaluate the clinical and electrophysiological features and the short-and long-term results of slow pathway RF ablation during ongoing AVNRT. Material and methods: A total of 282 consecutive patients with AVNRT undergoing RF catheter ablation were analysed. Patients whose tachycardia episodes could not be controlled during RF energy application and who underwent slow pathway ablation or modification during ongoing tachycardia formed the study group (group 1, n = 16) and those ablated during sinus rhythm formed the control group (group 2, n = 266). Results: Of the clinical characteristics, only the frequency of tachycardia attacks was higher in group 1 (3.3 ±1.2 vs. 2.1 ±0.9 attacks/month, p < 0.001). Among the baseline electrophysiological measurements, the echo zone lasted significantly longer in group 1 than in group 2 (78 ±25 ms vs. 47 ±18 ms; p < 0.001). The immediate procedural success rate was 100% in both groups. There were no significant differences between groups regarding the mean number of radiofrequency energy applications (5.2 ±4.2 vs. 5.8 ±3.9), total procedure times (42.4 ±30.5 min vs. 40.2 ±29.4 min) and fluoroscopy times (11.4 ±8.5 min vs. 12.2 ±9.3 min) (p > 0.050 for all). All patients were followed-up for 29 ±7 months; only 2 patients (< 1%) in group 2 recurred (p > 0.050). No permanent atrioventricular block was observed. Conclusions: The RF catheter ablation or modification of the slow pathway during ongoing AVNRT is feasible with acceptable short-and long-term efficacy and safety. However, this approach needs to be clarified with large-scale studies.
Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
Catheter ablation using radiofrequency energy became the non-pharmacological therapy of first choice for patients with supraventricular tachycardias. Modification of the atrioventricular nodal conduction using this source of energy can be performed to treat patients with atrioventricular nodal reentrant tachycardia. In this article the authors present an updated review of radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia and report their own experience in this field.
Catheter Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia
Circulation, 2016
Background: Because of its low prevalence, data on atypical atrioventricular nodal reentrant tachycardia (AVNRT) are scarce, and the optimal ablation method has not been established. Our study aimed at assessing the efficacy and safety of conventional slow pathway ablation, as applied for typical cases, in atypical AVNRT. Methods: We studied 2079 patients with AVNRT subjected to slow pathway ablation. In 113 patients, mean age 48.5±18.1 years, 68 female, atypical AVNRT or coexistent atypical and typical AVNRT without other concomitant arrhythmia was diagnosed. Ablation data and outcomes were compared with a group of age- and sex-matched control patients with typical AVNRT. Results: Fluoroscopy and radiofrequency current delivery times were not different in the atypical and typical groups, 20.3±12.2 versus 20.8±12.9 minutes ( P =0.730) and 5.9±5.0 versus 5.5±4.5 minutes ( P =0.650), respectively. Slow pathway ablation was accomplished from the right septum in 110 patients, and from t...
Circulation, 1999
Background-The purpose of this study was to evaluate the safety and efficacy of a temperature-controlled radiofrequency catheter ablation system. Methods and Results-The patient population included 1050 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway (AP), or the atrioventricular junction (AVJ). Ablation was successful in 996 patients. The probability of success was highest among patients who had undergone ablation of the AVJ, lowest in patients who had undergone ablation of an AP, and in between for patients who had undergone ablation of AVNRT. A major complication occurred in 32 patients. Four variables predicted ablation success (AVJ, AVNRT, or left free wall AP ablation and an experienced center). Four factors predicted arrhythmia recurrence (right free wall, posteroseptal, septal, and multiple APs). Two variables predicted development of a complication (structural heart disease and the presence of multiple targets), and 3 variables predicted an increased risk of death (heart disease, lower ejection fraction, and AVJ ablation).