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Journal of Interventional Cardiac Electrophysiology

, Volume 31, Issue 3, pp 207–215 | Cite as

Duration of the A(H)–A(Md) interval predicts occurrence of AV-block after radiofrequency ablation of the slow pathway

  • Markus C. Stühlinger
  • Kakhaber Etsadashvili
  • Xenia Stühlinger
  • Alexander Strasak
  • Thomas Berger
  • Wolfgang Dichtl
  • Franz X. Roithinger
  • Otmar Pachinger
  • Florian Hintringer
Article

Abstract

Purpose

Modification of the slow pathway (SP) of the atrio-ventricular node by radiofrequency ablation is the most effective treatment to cure AV nodal reentry tachycardia (AVNRT). However, this therapy may be complicated by AV-block (AVB). We sought to evaluate the predictive value of the A(H)A(Md) interval—the electrical delay between atrial signals on the His- and the ablation-catheter—upon development of AVB during SP ablation.

Methods

The associations between A(H)A(Md) interval, occurrence of ventriculo-atrial block (VAB) during junctional activity (JA) and transient or permanent AVB were analyzed retrospectively for 1585 RF applications at the SP in 393 patients diagnosed with AVNRT. The value of A(H)A(Md) was further tested prospectively in 118 AVNRT patients, who were only ablated at targets with intervals >20 ms.

Results

Forty-six RF deliveries resulted in transient or permanent AV-conduction disturbances. Shorter A(H)A(Md) intervals were associated with the occurrence of VAB during JA (p < 0.001) and AVB (p < 0.001). A(H)A(Md) was the strongest predictor for VAB or AVB in multivariate regression analyses, followed by the radiological distance between the catheters. In the prospective study, permanent high-degree AVB was not observed when the A(H)A(Md) at the ablation site was >20 ms.

Conclusion

The A(H)A(Md) interval is a better predictor for occurrence of conduction block during ablation for AVNRT than the radiological distance between the His- and the ablation-catheter. The risk of permanent AVB can be minimized, if only sites with an A(H)A(Md) longer than 20 ms are targeted for ablation.

Keywords

AV nodal reciprocating tachycardia AVNRT Complication Junctional tachycardia VA-block 

Abbreviations

AVB

Atrioventricular conduction block

CL

Cycle length

CS

Coronary sinus

EGM

Electrocardiogram

FP

Fast pathway

JA

Junctional activity, i.e., junctional ectopy

RF

Radiofrequency

SP

Slow pathway

VAB

Ventriculo-atrial conduction block

XR

Radiological distance between the His- and the ablation catheter on fluoroscopy

Notes

Acknowledgements

This study was supported by a grant from the “Jubiläumsfonds” from the Austrian National Bank (project # 11183).

Conflict of interest

None for any of the authors

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Markus C. Stühlinger
    • 1
  • Kakhaber Etsadashvili
    • 1
  • Xenia Stühlinger
    • 1
  • Alexander Strasak
    • 2
  • Thomas Berger
    • 1
  • Wolfgang Dichtl
    • 1
  • Franz X. Roithinger
    • 1
    • 3
  • Otmar Pachinger
    • 1
  • Florian Hintringer
    • 1
  1. 1.Department of Internal Medicine III/CardiologyMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
  3. 3.Department of Internal MedicineThermenklinikum MödlingMödlingAustria

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