Duration of the A(H)–A(Md) interval predicts occurrence of AV-block after radiofrequency ablation of the slow pathway
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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.
KeywordsAV nodal reciprocating tachycardia AVNRT Complication Junctional tachycardia VA-block
Atrioventricular conduction block
Junctional activity, i.e., junctional ectopy
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
- 1.Blomstrom-Lundqvist, C., Scheinman, M. M., Aliot, E. M., Alpert, J. S., Calkins, H., Camm, A. J., et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias–executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. Journal of the American College of Cardiology, 42(8), 1493–1531.PubMedCrossRefGoogle Scholar
- 2.Cosio, F. G., Anderson, R. H., Kuck, K. H., Becker, A., Borggrefe, M., Campbell, R. W., et al. (1999). Living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. a consensus statement from the cardiac nomenclature study group, working group of arrhythmias, European society of cardiology, and the task force on cardiac nomenclature from NASPE. Circulation, 100(5), e31–37.PubMedGoogle Scholar
- 5.Jackman, W. M., Beckman, K. J., McClelland, J. H., Wang, X., Friday, K. J., Roman, C. A., et al. (1992). Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. The New England Journal of Medicine, 327(5), 313–318.PubMedCrossRefGoogle Scholar
- 6.Kalbfleisch, S. J., Strickberger, S. A., Williamson, B., Vorperian, V. R., Man, C., Hummel, J. D., et al. (1994). Randomized comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of atrioventricular node reentrant tachycardia. Journal of the American College of Cardiology, 23(3), 716–723.PubMedCrossRefGoogle Scholar
- 7.Calkins, H., Yong, P., Miller, J. M., Olshansky, B., Carlson, M., Saul, J. P., et al. (1999). Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation, 99(2), 262–270.PubMedGoogle Scholar
- 8.Delise, P., Sitta, N., Zoppo, F., Coro, L., Verlato, R., Mantovan, R., et al. (2002). Radiofrequency ablation of atrioventricular nodal reentrant tachycardia: the risk of intraprocedural, late and long-term atrioventricular block. The Veneto Region multicenter experience. Ital Heart J, 3(12), 715–720.PubMedGoogle Scholar
- 12.Zrenner, B., Dong, J., Schreieck, J., Deisenhofer, I., Estner, H., Luani, B., et al. (2004). Transvenous cryoablation versus radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: a prospective randomized pilot study. European Heart Journal, 25(24), 2226–2231.PubMedCrossRefGoogle Scholar
- 18.Pandozi, C., Ficili, S., Galeazzi, M., Lavalle, C., Russo, M., Pandozi, A., et al. (2011). Propagation of the Sinus Impulse into the Koch's Triangle and Localization, Timing and Origin of the Multicomponent Potentials Recorded in this Area. Circulation: Arrhythmia and Electrophysiology, 4, 125–127.CrossRefGoogle Scholar
- 19.Delise, P., Bonso, A., Coro, L., Fantinel, M., Gasparini, G., Themistoclakis, S., et al. (2001). Pacemapping of the triangle of Koch: a simple method to reduce the risk of atrioventricular block during radiofrequency ablation of atrioventricular node reentrant tachycardia. Pacing and Clinical Electrophysiology, 24(12), 1725–1731.PubMedCrossRefGoogle Scholar