Abstract 15072: Long-term results of Catheter Ablation for Supraventricular Tachycardia Involving Twin Atrioventricular Nodes in Patients with Complex Heart Disease
Background: Supraventricular tachycardia (SVT) involving twin atrioventricular (AV) nodes often affects morbidity in complex heart disease. Although catheter ablation (CA) is performed for such SVT, its impact on long-term outcome remains unclear. The purpose of the present study was to evaluate acute and long-term effects of CA and surgical AV node modification (SAVM) for SVT involving twin AV nodes.
Method and Results: The presence of twin AV nodes was confirmed by electrophysiological (EP) study in thirty-five patients (pts) (mean age 6.8± 5.6 years) with complex heart disease including 21 heterotaxy syndrome and 14 AV discordance. SVT was induicible in 31 case of AV reciprocating tachycardia (AVRT) involving twin AV nodes, 2 of AV node reentrant tachycardia (AVNRT) of one of twin AV nodes and 2 of accessory pathway (Acp) reciprocating tachycardia which one of twin AV nodes acted as a bystander. In AVRT involving twin AV nodes, 17 exhibited an posterior AV node as an retrograde limb, 11 had a anterior AV node as retrograde limb, and 3 showed bidirectional AVRT. CA for one of twin AV nodes was performed in 29 pts for AVRT involving twin AV nodes. Targeted AV nodes were the anterior AV node in 8 and posterior AV node in 21. Acute success rate of AVN ablation was 90% (26/29). Acp ablation was performed in 2: one had successful CA and one had successful cryoablation. CA was not attempted for 2 pts with AVNRT. After EP study, 30 pts underwent cardiac surgery including 24 Fontan and 6 biventricular repairs. SAVM was performed in 7 pts including 2 with AVRT involving twin AV nodes without CA, 3 failed RFCA for AVRT involving twin AV nodes, and 2 with AVNRT RFCA were not attempted. During the follow-up after the EP study (mean 7.4± 5 years), 2 (6%) AVRT involving twin AV nodes including one successful CA and one failed CA following SAVM recurred within 6 months after CA, 2 (6%) AV block required pacemaker implantation and 4 (11%) new-onset atrial tachycardia (AT) occurred. One AVRT involving twin AV nodes and one AT were successfully ablated. During follow-up, there was no arrhythmic death despite 9 late deaths due to heart failure after cardiac surgery.
Conclusion: AV node ablation and SAVM are effective and acceptable therapy for reducing morbidity of SVT in complex heart disease with twin AV nodes.
- Supraventricular tachycardia
- Congenital heart disease
- Ablation, radiofrequency
- Atrioventricular node
- © 2010 by American Heart Association, Inc.