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(Circulation. 1996;94:3214-3220.)
© 1996 American Heart Association, Inc.

Articles

Inadvertent Atrioventricular Block During Radiofrequency Catheter Ablation

Results of the Pediatric Radiofrequency Ablation Registry

Michael S. Schaffer, MD; Michael J. Silka, MD; Bertrand A. Ross, MD; John D. Kugler, MD; and Participating Members of the Pediatric Electrophysiology Society*

the Section of Cardiology (M.S.S.), Department of Pediatrics, University of Colorado Medical School/The Children's Hospital, Denver, Colo; Oregon Health Sciences University (M.J.S.), Portland, Ore; Children's Hospital of the King's Daughter (B.A.R.), Norfolk, Va; and University of Nebraska Medical Center (J.D.K.), Omaha, Neb.

Background Inadvertent atrioventricular block is a complication of radiofrequency ablation. The present study is an analysis of the incidence, significance, and factors associated with inadvertent atrioventricular block during radiofrequency catheter ablation in childhood and adolescence.

Methods and Results The records of the Pediatric Radiofrequency Ablation Registry were reviewed. Between January 1, 1991, and April 1, 1994, atrioventricular block occurred in 23 of 1964 radiofrequency ablations (1.2%): 14 as third-degree block (3 transient) and 9 as second-degree block (5 transient). Atrioventricular block occurred from 5 seconds to 2 months (mean, 4.1 days; median, 15 seconds) after the onset of the energy application. Eight transient cases lasted 1 hour to 1 month (mean, 9.4 days; median, 7 days). Inadvertent atrioventricular block was related to the ablation anatomic site: 3 of 111 (2.7%) anteroseptal, 11 of 106 (10.4%) midseptal, and 2 of 197 (1.0%) right posteroseptal sites (P=.0007 for anteroseptal, P=.0001 for midseptal, and P=.17 for right posteroseptal versus nonright septal sites). Five of 314 (1.6%) ablations for atrioventricular nodal reentrant tachycardia resulted in atrioventricular block (P=.004 versus nonright septal sites). Compared with a matched subgroup, radiofrequency ablation experience was the only significant risk factor (32.7 versus 106.6, P=.002) for the occurrence of atrioventricular block.

Conclusions Inadvertent atrioventricular block may occur during or late after radiofrequency catheter ablation. It is associated with ablations for (1) anterior and midseptal accessory pathways and atrioventricular nodal reentry and (2) relative institutional inexperience.

Key Words: catheter ablation • heart block • pediatrics

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