Circulation, Vol 90, 2815-2819, Copyright © 1994 by American Heart Association
AS Manolis, PJ Wang and NA Estes 3rd
BACKGROUND: Residual slow pathway conduction in the form of persistent jump
in the atrioventricular (AV) conduction time or atrial echo beats is a
common finding after successful radiofrequency (RF) ablation of the slow
pathway in patients with AV nodal reentrant tachycardia (AVNRT). Sites of
successful RF ablation of the slow pathway may be located anteriorly in the
tricuspid annulus (cephalad to the coronary sinus os) or posteriorly (at,
within, or caudal to the coronary sinus os). The aim of this study was to
investigate whether arrhythmia recurrences correlate with persistent slow
pathway conduction or site of successful ablation. METHODS AND RESULTS:
Among 55 patients with symptomatic AVNRT having RF ablation, 23 patients
(42%) (group 1) had evidence of persistent dual AV nodal pathway physiology
and/or echo beats, whereas in 32 patients (group 2), slow pathway
conduction had been completely eliminated. With regard to ablation sites,
14 patients (25%) (group A) had their slow pathway successfully ablated at
an inferoposterior site, whereas in 41 patients (group B), the ablation
site was located anteriorly to the coronary sinus os. The study patients
included 17 men and 38 women, aged 37 +/- 18 years. The
electrophysiological study and RF ablation were performed in a single
session in 50 patients (91%). After the first session, the technique was
successful in all patients (100%), with elimination of AVNRT and without
affecting AV conduction. A mean of 9 +/- 6 lesions were applied. The total
procedure time averaged 4 +/- 1 hours. Fluoroscopy time was 41 +/- 25
minutes. Except for transient AV block in 1 patient, no other complications
occurred. Over 12 +/- 8 months, a total of 7 patients (13%) had recurrence
of AVNRT, and 6 of them underwent successful repeat slow pathway RF
ablation. Recurrence rate was 9% (2 patients) for group 1, with persistent
jump or echo beats, and 16% (5 patients) for group 2, without residual slow
pathway conduction (P = NS). Five of the recurrences (71%) were noted in
group A and 2 in group B. Thus, the recurrence rate was 36% for group A (5
of 14 patients), with posterior ablations, and 5% for group B (2 of 41
patients), with anterior sites of successful RF ablation (P < .05).
CONCLUSIONS: After successful RF ablation of the slow pathway in patients
with AVNRT, residual slow pathway conduction does not correlate with
clinical tachycardia recurrences. However, the site of successful RF
ablation of the slow pathway does correlate with arrhythmia recurrences.
More recurrences are observed when the site is located inferoposteriorly,
at or below the os of the coronary sinus, as compared with medial and
anterior locations of the ablation site.
ARTICLES
Radiofrequency ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia. Do arrhythmia recurrences correlate with persistent slow pathway conduction or site of successful ablation?
Department of Medicine, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111.
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