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



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.


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.


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.


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.


AV nodal reciprocating tachycardia AVNRT Complication Junctional tachycardia VA-block 



Atrioventricular conduction block


Cycle length


Coronary sinus




Fast pathway


Junctional activity, i.e., junctional ectopy




Slow pathway


Ventriculo-atrial conduction block


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



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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