Circulation, Vol 83, 827-835, Copyright © 1991 by American Heart Association
MA Lee, F Morady, A Kadish, DJ Schamp, MC Chin, MM Scheinman, JC Griffin, MD Lesh, D Pederson and J Goldberger
BACKGROUND. The utility of transcatheter application of radiofrequency
energy to eliminate atrioventricular nodal reentrant tachycardia (AVNRT)
was investigated. METHODS AND RESULTS. Thirty-nine patients (mean age, 53
+/- 20 years; range 14-86 years) with medically refractory AVNRT underwent
perinodal ablation with radiofrequency energy. A custom-designed 6F
catheter with a large (3-mm-long) distal electrode and interelectrode
pacing of 2 mm was used in the majority of cases. The catheter used for
ablation was initially positioned across the tricuspid anulus to obtain the
largest His bundle electrogram, then withdrawn to obtain the largest
atrial:ventricular electrogram ratio, with a small His bundle electrogram
(less than or equal to 100 microV). Each application of radiofrequency
energy (350-550 kHz, 16.2 +/- 5.2 W) was stopped after 60 seconds or if PR
prolongation or an impedance rise was noted. The endpoints of the procedure
were persistent modification of atrioventricular nodal conduction (either
first-degree atrioventricular block or impairment of ventriculoatrial
conduction) and noninducibility of AVNRT before and during isoproterenol
administration. Radiofrequency energy was applied a mean of 6.8 +/- 3.5
times per session. After a mean follow-up of 8 +/- 3.0 months, 32 of the 39
patients (82%) have been free of AVNRT, and did not have high grade AV
block. Three patients (8%) developed complete atrioventricular block and
had pacemakers implanted. Two patients had unsuccessful initial procedures,
and two patients had initially successful ablations but had recurrences of
tachycardia 4-6 weeks later. Elimination of AVNRT appeared to be due to
effects on the retrograde fast pathway in most patients. CONCLUSIONS.
Radiofrequency ablation of the perinodal right atrium appears to be safe
and effective for treatment of typical AVNRT.
ARTICLES
Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia
Department of Medicine, University of California, San Francisco.
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