Circulation, Vol 70, 1024-1029, Copyright © 1984 by American Heart Association
MM Scheinman and T Evans-Bell
An international registry was formed to collate data for patients
undergoing attempted catheter ablation of the atrioventricular (AV)
junction and insertion of a permanent pacemaker. Over the past 2 years,
data was submitted for 127 patients who were followed for a mean of 9.9 +/-
8.2 months. The most common arrhythmia treated was chronic or paroxysmal
atrial fibrillation or flutter (78 patients, 61%); the remainder had
supraventricular tachycardia due to AV node reentry, ectopic atrial
tachycardia, or incorporated an accessory pathway. A single shock of 150 to
400 J was effective in producing chronic third- degree AV block in 45
patients while two or more shocks were used in an additional 45 patients.
There was no significant difference in the total cumulative energy used in
successful and unsuccessful procedures. Immediate complications related to
the shock included ventricular fibrillation (one patient), pericardial
tamponade (one patient), and transient hypotension (one patient). No
chronic sequelae occurred as a result of these complications. Late
complications (1 day to 1 month) included ventricular tachycardia (three
patients), sepsis involving the pacemaker pocket (two patients),
staphylococcal sepsis from temporary pacing catheter (one patient),
thrombophlebitis (one patient), thrombosis of the left subclavian vein (one
patient), and hemothorax (one patient). Follow-up evaluation revealed
chronic third degree AV block in 90 (71%) and AV conduction resumed but no
drugs were required for arrhythmia control in eight (6.5%) and arrhythmia
control was achieved with previously ineffective drugs in 16 (13%).
Thirteen patients (10%) had no improvement and five of these patients
underwent cardiac electrosurgery for direct His bundle ablation.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Catheter ablation of the atrioventricular junction: a report of the percutaneous mapping and ablation registry
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