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

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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.

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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

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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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Authors and Affiliations

  1. Department of Internal Medicine III/Cardiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Markus C. Stühlinger, Kakhaber Etsadashvili, Xenia Stühlinger, Thomas Berger, Wolfgang Dichtl, Franz X. Roithinger, Otmar Pachinger & Florian Hintringer

  2. Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria

    Alexander Strasak

  3. Department of Internal Medicine, Thermenklinikum Mödling, Mödling, Austria

    Franz X. Roithinger

Authors
  1. Markus C. Stühlinger
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  2. Kakhaber Etsadashvili
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  3. Xenia Stühlinger
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  4. Alexander Strasak
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  5. Thomas Berger
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  7. Franz X. Roithinger
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  8. Otmar Pachinger
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  9. Florian Hintringer
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Corresponding author

Correspondence to Markus C. Stühlinger.

Additional information

Markus C. Stühlinger and Kakhaber Etsadashvili contributed equally to the study.

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Stühlinger, M.C., Etsadashvili, K., Stühlinger, X. et al. Duration of the A(H)–A(Md) interval predicts occurrence of AV-block after radiofrequency ablation of the slow pathway. J Interv Card Electrophysiol 31, 207–215 (2011). https://doi.org/10.1007/s10840-011-9578-9

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  • DOI: https://doi.org/10.1007/s10840-011-9578-9

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