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Watanabe T, Hachiya H, Watanabe H, Anno K, Okuyama T, Harunari T, Yokota A, Kamioka M, Komori T, Torigoe‐Kurosu Y, Makimoto H, Kabutoya T, Kimura Y, Imai Y, Kario K. Relationship between the atrial-activation pattern around the triangle of Koch and successful ablation sites in slow-fast atrioventricular nodal reentrant tachycardia. J Arrhythm 2024; 40:363-373. [PMID: 38586857 PMCID: PMC10995602 DOI: 10.1002/joa3.12999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 04/09/2024] Open
Abstract
Background The precise details of atrial activation around the triangle of Koch (ToK) remain unknown. We evaluated the relationship between the atrial-activation pattern around the ToK and success sites for slow-pathway (SP) modification ablation in slow-fast atrioventricular reentrant tachycardia (AVNRT). Methods Thirty patients with slow-fast AVNRT who underwent successful ablation were enrolled. Atrial activation around the ToK during sinus rhythm was investigated using ultra-high-density mapping pre-ablation. The relationships among features of atrial-activation pattern and success sites were examined. Results Of 30 patients (22 cryoablation; 8 radiofrequency ablation), 26 patients had a collision site of two wavefronts of delayed atrial activation within ToK, indicating a success site. The activation-search function of Lumipoint software, which highlights only atrial activation with a spatiotemporal consistency, showed non-highlighted area on the tricuspid-annulus side of ToK. In 23 of the patients, a spiky potential was recorded at that collision site outside the Lumipoint-highlighted area. Fifteen cryoablation patients with a success site coincident with a collision site outside the Lumipoint-highlighted area had significantly more frequent disappearances of SP after initial cryoablation (46.7% vs. 0%, p = .029), fewer cryoablations (3.7 ± 1.8 vs. 5.3 ± 1.3, p = .045), and shorter procedure times (170 ± 57 vs. 228 ± 91 min, p = .082) compared to the seven cryoablation patients without such sites. Four patients had transient AV block by ablation inside the Lumipoint-highlighted area with fractionated signals, but no patient developed permanent AV block or recurrence post-procedure (median follow-up: 375 days). Conclusions SP modification ablation at the collision site of atrial activation of the tricuspid-annulus side along with a spiky potential could provide a better outcome.
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Affiliation(s)
- Tomonori Watanabe
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Hitoshi Hachiya
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
- Cardiovascular Center, Tsuchiura Kyodo HospitalIbarakiJapan
| | - Hiroaki Watanabe
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazunori Anno
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takafumi Okuyama
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomohiko Harunari
- Division of Cardiovascular Medicine, Shin‐Oyama City HospitalTochigiJapan
| | - Ayako Yokota
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Masashi Kamioka
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takahiro Komori
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuko Torigoe‐Kurosu
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Hisaki Makimoto
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yoshifumi Kimura
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yasushi Imai
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
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Abdelrahim E, Birchak J, Khan A, Maskoun W. Iatrogenic cardiomyopathy in patients with manifest right supero-paraseptal accessory pathways. Pacing Clin Electrophysiol 2023; 46:1370-1374. [PMID: 36851895 DOI: 10.1111/pace.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/12/2022] [Accepted: 02/18/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION We describe two patients with right supero-paraseptal accessory pathway (SPAP) who developed left ventricular dysfunction associated with an increased degree of ventricular pre-excitation and frequent orthodromic reciprocating tachycardia (ORT) due to worsening atrioventricular (AV) node conduction. METHODS AND RESULTS Case 1: 48-year-old female with a history of normally functioning mechanical mitral valve, CABG, and ventricular pre-excitation that worsened after her open heart surgery. She presented with frequent palpitations with documented supraventricular tachycardia (SVT) and found to have a new left ventricular dysfunction with decrease in left ventricular ejection fraction (LVEF) from 55% to 46% with dyssynchrony. An electrophysiological study confirmed a right SPAP and ORT. The pathway was successfully ablated from the antegrade approach after careful mapping. After ablation and 6-month follow up echocardiogram showed improvement of EF to 54% and the LV dyssynchrony resolved. Case 2: 51-year-old male with a history of frequent SVT with recent unsuccessful ablations that resulted in worsening ventricular pre-excitation, more frequent SVT, and new left ventricular dysfunction (LVEF from 60% to 40%). He was started on amiodarone which resulted in significant sinus bradycardia, intermittent ventricular pre-excitation, and first degree AV block with significant increase in ORT events. His electrophysiology study confirmed SPAP which was successfully ablated from the antegrade approach after careful mapping. After 1 month, follow-up echocardiogram showed an improved ejection fraction to 60%. CONCLUSION Left ventricular dysfunction due to dyssynchrony and symptomatic frequent ORT of right SPAP can develop in the setting of new iatrogenic diminished AV node conduction. Successful ablation will result in LV function recovery to baseline.
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Affiliation(s)
- Elsheikh Abdelrahim
- Division of Electrophysiology, Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan, USA
| | - John Birchak
- Division of Electrophysiology, Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan, USA
| | - Arfaat Khan
- Division of Electrophysiology, Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan, USA
| | - Waddah Maskoun
- Division of Electrophysiology, Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan, USA
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Vahid Lotfabadi N, Mehrabi S, Heidari‐Bakavoli A, Morovatdar N, Tayyebi M, Baradaran Rahimi V. Evaluation of the effects of isoproterenol on arrhythmia recurrence following catheter ablation in patients with atrioventricular nodal re-entrant tachycardia: A randomized controlled clinical trial. Pharmacol Res Perspect 2023; 11:e01068. [PMID: 36855813 PMCID: PMC9975462 DOI: 10.1002/prp2.1068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
We aimed to determine the effects of isoproterenol on arrhythmia recurrence in atrioventricular nodal re-entrant tachycardia (AVNRT) patients treated with catheter ablation. The present randomized controlled clinical trial was conducted on AVNRT patients candidates for radiofrequency ablation (RFA). The patients were randomly assigned to receive isoproterenol (0.5-4 μg/min) or not (control group) for arrhythmia re-induction after ablation. The results of the electrophysiological (EP) study, the ablation parameters, and the arrhythmia recurrence rate were recorded. We evaluated 206 patients (53 males and 153 females) with a mean (SD) age of 49.87 (15.5) years in two groups of isoproterenol (n = 103) and control (n = 103). No statistically significant difference was observed between the two studied groups in age, gender, EP study, and ablation parameters. The success rate of ablation was 100% in both groups. During ~16.5 months of follow-up, one patient (1%) in the isoproterenol group and four patients (3.8%) in the control group experienced AVNRT recurrence (HR = 0.245; 95% confidence interval [CI], 0.043-1.418; p = .173). Based on the Kaplan-Meier analysis, there was no significant difference in the incidence rate of arrhythmia recurrence during the follow-up period between the two studied groups (p = .129). Additionally, there were no significant differences between the arrhythmia's recurrence according to age, gender, junctional rhythm, type of AVNRT arrhythmia, and DAVN persistence after ablation. Although isoproterenol administration for arrhythmia re-induction after ablation did not alleviate the treatment outcomes and arrhythmia recurrence following RFA in AVNRT patients, further studies with a larger sample size and a longer duration of follow-up are necessary.
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Affiliation(s)
- Neda Vahid Lotfabadi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Saeed Mehrabi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Alireza Heidari‐Bakavoli
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of MedicineImam Reza Hospital, Mashhad University of Medical SciencesMashhadIran
| | - Mohammad Tayyebi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Pharmacological Research Center of Medicinal PlantsMashhad University of Medical SciencesMashhadIran
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Effect of Direct Slow Pathway Capture Mapping-Guided Ablation on Typical Atrioventricular Nodal Re-Entrant Tachycardia. JACC Clin Electrophysiol 2023; 9:209-218. [PMID: 36858687 DOI: 10.1016/j.jacep.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Direct slow pathway capture (DSPC) mapping is a novel electrophysiological technique for detecting antegrade slow pathway input sites. However, the effect of DSPC mapping-guided ablation on atrioventricular nodal re-entrant tachycardia (AVNRT) is unknown. OBJECTIVES This study aimed to evaluate the efficacy and safety of DSPC mapping-guided ablation in typical AVNRT patients. METHODS A multicenter retrospective study was conducted in 301 consecutive typical AVNRT patients. The outcomes in patients who underwent DSPC mapping-guided ablation (DSPC group) and those who underwent conventional anatomical ablation (conventional group) were compared. The conventional group was established before introducing DSPC mapping-guided ablation. Positive DSPC sites were defined as sites with a return cycle atrioventricular prolongation of ≥20 ms with high-output (10-20 V) pacing during tachycardia or the last paced beat of the atrial extrastimulation. RESULTS Among 116 patients in the DSPC group, 102 (88%) had positive DSPC sites, and 86 (74%) had a successful ablation at that site. Of the remaining 30 patients, 27 had a successful anatomical ablation. The DSPC group had a significantly lower frequency of radiofrequency applications and shorter total application time than the conventional group (median: 5.5 [IQR: 3-11] times vs 9 [IQR: 5-15] times, and 168 [IQR: 108-266] seconds vs 244 [IQR: 158-391] seconds, respectively; P < 0.01). Moreover, the DSPC group had a numerically lower incidence of permanent pacemaker implantations and AVNRT recurrences than the conventional group (0% vs 1.6%; P = 0.17, and 1.7% vs 3.2%; P = 0.43, respectively). CONCLUSIONS DSPC mapping-guided ablation was associated with a lower operative time, which can reduce the risk of AV conduction injury in typical AVNRT.
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Watanabe T, Yokoyama Y, Hachiya H, Okuyama T, Watanabe H, Yokota A, Kamioka M, Komori T, Kabutoya T, Imai Y, Kario K. Electrogram characteristics at successful cryoablation sites in slow-fast atrioventricular nodal reentrant tachycardia. J Electrocardiol 2022; 75:44-51. [PMID: 36306606 DOI: 10.1016/j.jelectrocard.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/03/2022] [Accepted: 09/15/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Cryoablation is a safe alternative to radiofrequency (RF) ablation for slow-fast atrioventricular reentrant tachycardia (AVNRT); however, optimal electrogram parameters for site selection remain unknown. We retrospectively investigated local electrograms for slow pathway (SP) modification in cryoablation. METHODS Forty-five consecutive patients with slow-fast AVNRT who underwent cryoablation using a 6-mm-tip catheter were enrolled. Electrogram parameters for sites of successful SP modification (success-sites) were investigated; these included the interval between atrial activation at His and the last deflection of SP potential, defined as the His(A)-SPP interval. In 8 patients, 3-dimensional mapping by multi-electrode catheter was performed pre-ablation for more detailed SP assessment. RESULTS Twenty-seven of 45 patients had successful SP modification by 1 cycle of freeze-thaw-freeze cryoablation at a single site with a low amplitude and fragmented SP potential. Among a total of 76 cryoablation sites in all patients, the His(A)-SPP interval at success-sites (45 sites) was significantly longer than that at unsuccess-sites (31 sites) (86 ± 9 vs.78 ± 10 msec, p < 0.0001). The AV amplitude ratio was not significantly different between success-and unsuccess-sites (0.21 ± 0.22 vs.0.25 ± 0.23, p = 0.429). The cutoff value of the His(A)-SPP interval for successful cryoablation was 82 msec with a sensitivity of 0.67 and specificity of 0.71 (AUC: 0.739; 95%CI: 0.626-0.852; p < 0.0001). Three-dimensional mapping in all 8 patients showed that sites with the most delayed atrial activation and the last deflection of the fragmented SP potential within the Koch's triangle coincided with success-sites. CONCLUSION A longer His(A)-SPP interval and fractionated SP potential were characteristics of successful cryoablation for SP modification in slow-fast AVNRT.
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Affiliation(s)
- Tomonori Watanabe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Yasuhiro Yokoyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hitoshi Hachiya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Takafumi Okuyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroaki Watanabe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ayako Yokota
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masashi Kamioka
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yasushi Imai
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Sim MG, Chan SP, Kojodjojo P, Tan ES. Late pacemaker implantation after atrioventricular nodal reentrant tachycardia ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2022; 33:2297-2304. [PMID: 36124400 DOI: 10.1111/jce.15680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Catheter ablation (CA) of atrioventricular nodal reentrant tachycardia (AVNRT) is associated with late pacemakers for AV block (AVB). We performed a systematic review and meta-analysis of the pooled incidence of late pacemakers for AVB after CA of AVNRT. METHODS AND RESULTS Relevant studies were identified from 4 electronic databases (PubMed, EMBASE, Scopus, Cochrane Trial Register) from inception to 2022. A random effects model was used to calculate the odds of late pacemakers in CA of AVNRT compared to atrioventricular reentrant tachycardia (AVRT). Of 533 articles screened, 13 were included in systematic review. CA for AVNRT was performed in 16,471 patients (mean age 54±17 years, 63% females), of which 68 (0.4%) underwent pacemaker implantation for late AVB. Meta-analysis was performed in 5 of the 13 studies (mean follow-up duration 7±4 years). Patients who underwent CA of AVNRT were older (58±17 vs 52±20 years, p<0.001), and more likely female (60% vs 41%, p<0.001) than AVRT. Pooled estimates of late pacemakers for AVB were higher in CA of AVNRT than AVRT (0.5% vs 0.2%, p=0.006), with CA in AVNRT associated with almost 2-fold increased odds of late pacemakers indicated for AVB (OR 1.94, 95%CI 1.08-3.47, p=0.027) compared to AVRT. CONCLUSION AVNRT ablation is safe but associated with a low but definitely increased risk of requiring pacing in the later years due to AVB. This association is confirmed by pooling over 16,000 AVNRT patients receiving clinically indicated ablation and is helpful in providing informed consent for prospective patients undergoing ablation for AVNRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming Gin Sim
- Yong Loo Lin School of Medicine, National University, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University, Singapore
| | - Pipin Kojodjojo
- Yong Loo Lin School of Medicine, National University, Singapore.,Department of Cardiology, National University Heart Centre, Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Eugene Sj Tan
- Yong Loo Lin School of Medicine, National University, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
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Tan ESJ, Chan SP, Seow SC, Teo WS, Ching CK, Chong DTT, Tan VH, Chia PL, Foo DCG, Kojodjojo P. Outcomes of supraventricular tachycardia ablation: Results from the Singapore ablation and cardiac devices registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:50-58. [PMID: 34792208 DOI: 10.1111/pace.14410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/11/2021] [Accepted: 11/14/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Singapore Cardiac Databank was designed to monitor the performance and outcomes of catheter ablation. We investigated the outcomes of paroxysmal supraventricular tachycardia (PSVT)-ablation in a prospective, nationwide, cohort study. METHODS Atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), or atrial tachycardia (AT)-ablations in Singapore from 2010 to 2018 were studied. Outcomes include acute success, periprocedural-complications, postoperative pacing requirement, arrhythmic recurrence and 1-year all-cause mortality. RESULTS Among 2260 patients (mean age 45 ± 18 years, 50% female, 57% AVNRT, 37% AVRT, 6% AT), overall acute success rates of PSVT-ablation was 98.4% and increased in order of AT, AVRT, and AVNRT (p < .001). Periprocedural cardiac tamponade occurred in two AVRT patients. A total of 15 pacemakers (6 within first 30-days, 9 after 30-days) were implanted (seven AV block, eight sinus node dysfunction [SND]), with the highest incidence of pacemaker implantation after AT-ablation (5% vs. 0.6% AVNRT vs. 0.1% AVRT, p < .001). Repeat ablations (0.9% AVNRT, 7% AVRT, 4% AT, p < .001) were performed in 78 (3.5%) patients and 13 (0.6%) patients died within a year of ablation. Among outcomes considered adjusting for age, sex, PSVT-type and procedure-time, AT was independently associated with 6-fold increased odds of total (adjusted odds ratio [AOR] 6.32, 95% confidence interval [CI] 1.95-20.53) and late (AOR 6.38, 95% CI 1.39-29.29) pacemaker implantation, while AVRT was associated with higher arrhythmic recurrence with repeat ablations (AOR 4.72, 95% CI 2.36-9.44) compared to AVNRT. CONCLUSIONS Contemporary PSVT ablation is safe with high acute success rates. Long-term outcomes differed by nature of the PSVT.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Siew Pang Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Wee Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Daniel T T Chong
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - David C G Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
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- Department of Cardiology, National University Heart Centre, Singapore, Singapore
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Blockhaus C, Gülker JE, Bufe A, Seyfarth M, Koektuerk B, Shin DI. Reduction of Radiation Exposure in Atrioventricular Nodal Reentrant Tachycardia Ablations Using an Electroanatomical Mapping System With Fluoroscopy Integration Module. Front Cardiovasc Med 2021; 8:728422. [PMID: 34746250 PMCID: PMC8563834 DOI: 10.3389/fcvm.2021.728422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia. Current guidelines recommend electrophysiology study (EPS) and ablation, which have been proven to show high success rates with very low complication rates. Usually, ablation of AVNRT is performed conventionally using only fluoroscopy. Electroanatomical mapping systems (EMS) are widely used in complex arrhythmias. One of their advantages is their potential in decreasing the need of fluoroscopy time (FT). In this study we analyzed patients undergoing either conventional AVNRT ablation or by using an EMS with a fluoroscopy integrating system (FIS). Materials and Methods: We included 119 patients who underwent AVNRT ablation in our study. Eighty-nine patients were ablated conventionally using only fluoroscopy, 30 patients were ablated using EMS + FIS. Results: We found that the use of EMS + FIS led to a significant reduction of FT (449.90 ± 217.21 vs. 136.93 ± 109.28 sec., p < 0.001) and dose-area-product (DAP, 268.27 ± 265.20 vs. 41.07 ± 27.89 μGym2, p < 0.001) without affecting the procedure time (PT, 66.55 ± 13.3 vs. 67.33 ± 13.81 min, p = 0.783). Furthermore, we found no significance with regard to complications. Conclusion: The use of EMS+FIS is safe and feasible. It leads to a significant reduction of both FT and DAP without affecting PT and safety. Hence, EMS + FIS is beneficial for both the operator and the patients by reducing the radiation exposure.
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Affiliation(s)
- Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.,Witten-Herdecke University, Witten, Germany
| | - Jan-Erik Gülker
- Witten-Herdecke University, Witten, Germany.,Department of Cardiology, Petrus Hospital, Wuppertal, Germany
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.,Witten-Herdecke University, Witten, Germany
| | - Melchior Seyfarth
- Witten-Herdecke University, Witten, Germany.,Department of Cardiology, University Hospital Helios Wuppertal, Wuppertal, Germany
| | - Buelent Koektuerk
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.,Witten-Herdecke University, Witten, Germany
| | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.,Witten-Herdecke University, Witten, Germany
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9
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Decroocq M, Rousselet L, Riant M, Norberciak L, Viart G, Guyomar Y, Graux P, Maréchaux S, Germain M, Menet A. Periprocedural, early, and long-term risks of pacemaker implantation after atrioventricular nodal re-entry tachycardia ablation: a French nationwide cohort. Europace 2021; 22:1526-1536. [PMID: 32785702 DOI: 10.1093/europace/euaa151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
AIMS Pacemaker implantation (PI) after atrioventricular nodal re-entry tachycardia (AVNRT) ablation is a dreadful complication. We aimed to assess periprocedural, early, and late risks for PI. METHODS AND RESULTS All 27 022 patients who underwent latest AVNRT ablation in France from 2009 to 2017, were identified in the nationwide medicalization database. A control group of 305 152 patients hospitalized for arm, leg, or skin injuries with no history of AVNRT or supraventricular tachycardia were selected. After propensity score matching, both groups had mean age of 53 ± 18 years and were predominantly female (64%). During this 9-year period, 822 of 27 022 (3.0%) AVNRT patients underwent PI, with significant higher risk in propensity-matched AVNRT patients compared to propensity-matched controls [2.9% vs. 0.9%; hazard ratio 3.4 (2.9-3.9), P < 0.0001]. This excess risk was significant during all follow-up, including periprocedural (1st month), early (1-6 months), and late (>6 months) risk periods. Annualized late risk per 100 AVNRT patients was 0.2%. In comparison to controls, excess risk was 0.2% in <30-year-old AVNRT patients; 0.7% in 30-50-year-old; 1.1% in 50-70-year-old and 6.5% over 70-year-olds. Risk for PI was also significantly different according to three procedural factors: centres, experience, and ablation date, with a 30% decrease since 2015. CONCLUSION Periprocedural, early, and late risks for PI were higher after AVNRT ablation compared to propensity-matched controls. Longer follow-up is needed as the excess risk seems to persist late after AVNRT ablation.
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Affiliation(s)
- Marie Decroocq
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Louis Rousselet
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département d'Information Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Margaux Riant
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Recherche Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Laurène Norberciak
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Recherche Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Guillaume Viart
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Yves Guyomar
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Pierre Graux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Sylvestre Maréchaux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
| | - Marysa Germain
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département d'Information Médicale, Université Catholique de Lille, F-59000 Lille, France
| | - Aymeric Menet
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France
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Wegner FK, Habbel P, Schuppert P, Frommeyer G, Ellermann C, Lange PS, Leitz P, Köbe J, Wasmer K, Eckardt L, Dechering DG. Predictors of AVNRT Recurrence After Slow Pathway Modification. Int Heart J 2021; 62:72-77. [PMID: 33455989 DOI: 10.1536/ihj.20-463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atrioventricular nodal reentry tachycardia (AVNRT) is the most common regular supraventricular tachycardia (SVT). Slow pathway modification (SPM) is the accepted first line treatment with reported success rates around 95%. Information regarding possible predictors of AVNRT recurrence is scarce.Out of 4170 consecutive patients with SPM in our department from 1993-2018, we identified 78 patients (1.9%) receiving > 1 SPM (69% female, median age 50 years) with a recurrence of AVNRT after a successful SPM. We matched these patients for age, gender and number of radiofrequency applications during first SPM with 78 patients who received one successful SPM in our center without AVNRT recurrence. Both groups were analyzed for possible predictors of a recurrence of AVNRT during long-term follow-up. The recurrence group contained a significantly lower proportion of patients with an occurrence of junctional beats during SPM (69% versus 89%, P = 0.006). Moreover, significantly more cases of previously diagnosed atrial fibrillation/tachycardia (AF/AT; 21% versus 5%, P = 0.007) and inducible AF/AT during electrophysiology study (23% versus 6%, P = 0.006) were present in the recurrence group. While more than half of patients had a recurrence within the first year, in 20% symptoms reappeared ≥ 4 years after ablation.In a small percentage of patients, AVNRT recurs after an initially successful ablation. Interestingly, these patients had significantly fewer junctional beats during ablation and a higher rate of other (inducible) arrhythmias. AVNRT recurrence spanned a considerable timeframe and should remain a differential diagnosis, even years after ablation.
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Affiliation(s)
- Felix K Wegner
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Pia Habbel
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Piet Schuppert
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Gerrit Frommeyer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Christian Ellermann
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Philipp S Lange
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Patrick Leitz
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
| | - Dirk G Dechering
- Department of Cardiology II - Electrophysiology, University Hospital Muenster
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11
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Yamamoto M, Tachibana M, Banba K, Hasui Y, Matsumoto K. Effectiveness of a 3D mapping benchmark for ablation in patients with atrioventricular nodal reentrant tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1546-1553. [PMID: 33179794 DOI: 10.1111/pace.14104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/03/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Avoiding excessively fast junctional rhythm (JR) during slow pathway (SP) modification for atrioventricular nodal reentrant tachycardia (AVNRT) helps prevent serious atrioventricular block. This study investigated the usefulness of a predictive ablation point that lies near the boundary line between appropriate and excessively fast JRs with three-dimensional (3D) electroanatomical mapping in AVNRT patients. METHODS Participants were 141 consecutive patients with common AVNRT who received anatomical ablation to an antegrade SP at our institution between August 2013 and December 2019. Patients were divided into two groups: Group A, treated using a location marker that predicts successful ablation sites in a 3D mapping system, and Group B, treated prior to the development of this marker and therefore without it. RESULTS The average age was 61.9 ± 16.9 years, and 41.1% of patients were male. Excessively fast JRs appeared less frequently in Group A than in Group B, though this difference did not reach significance. The distance from the His bundle to the successful ablation point was significantly longer in Group A than in Group B (13.4 ± 4.5 vs 10.8 ± 4.4 mm, P < .01). The number of ablations near the successful ablation point was significantly lower in Group A (6.5 ± 5.2 vs 11.4 ± 9.9, P < .01), and a greater number of accelerated JRs at the successful ablation point were observed in Group A (46.9 ± 29.2 vs 32.8 ± 19.2, P < .01). CONCLUSION Using our benchmark for a predictive successful ablation point in 3D mapping simplifies and improves common AVNRT ablation procedures.
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Affiliation(s)
- Masanori Yamamoto
- Departments of Medical Engineering, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Motomi Tachibana
- Departments of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kimikazu Banba
- Departments of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yusuke Hasui
- Departments of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kensuke Matsumoto
- Departments of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
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12
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Chin CG, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Vicera JJB, Chen CC, Chuang CM, Cheng WH, Liu SH, Hsieh MH, Chen SA. Extremely late recurrences (≥3 years) of atrioventricular nodal reentrant tachycardia: Electrophysiological characteristics of the index and repeat ablation procedures. Int J Cardiol 2020; 305:70-75. [PMID: 32059994 DOI: 10.1016/j.ijcard.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter ablation is an effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). However, the characteristics of extremely late (>3 years) recurrences of AVNRT after a successful initial ablation are not fully elucidated. We aimed to explore the electrophysiological characteristics of extremely late recurrences of AVNRT after a successful ablation. METHODS From 1991 to 2018, 3311 patients (mean age: 48.7 ± 17.4 years; men: 1328 [40.1%]) who underwent catheter ablation for AVNRT were investigated. Baseline characteristics of the patients, recurrence status, and detailed electrophysiological parameters of the index and repeat ablation procedures were obtained for analysis. RESULTS After a mean follow-up period of 129.5 ± 58.0 months, 65 (2.0%) patients underwent repeat ablation for recurrences of AVNRT, of whom 17 (0.5%) presented with extremely late recurrences. The incidence of transient AV block was significantly higher in patients with extremely late recurrences (5.9%) than in those without recurrences (1.9%) but lower than that in patients with recurrences within <3 years (12.5%, P < .001). In addition, among patients with extremely late recurrences of AVNRT, the atrial-His bundle interval was significantly longer (99.1 ± 23.4 vs. 76.5 ± 13.1 ms, P < .01) and the need for intravenous isoproterenol and/or atropine for the induction of AVNRT (88.2% vs. 47.1%, P = .03) was higher in the repeat ablation procedure than in the index ablation procedure. CONCLUSION Recurrences of AVNRT can occur 3 years after a successful initial ablation. The electrophysiological features of the index and repeat ablation procedures differed between patients with extremely late recurrences of AVNRT and those with recurrences within <3 years.
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Affiliation(s)
- Chye-Gen Chin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; University of Santo Tomas Hospital, Manila, Philippines
| | - Chun-Chao Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Mao Chuang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Pediatric Cardiology, Chinese Medical University Children's Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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Symptomatic arrhythmias after catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT): results from the German Ablation Registry. Clin Res Cardiol 2019; 109:858-868. [PMID: 31784903 DOI: 10.1007/s00392-019-01576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In atrioventricular nodal reentrant tachycardia (AVNRT), catheter ablation is considered as first-line therapy. Despite high success rates, some patients present with arrhythmia recurrence or develop other types of arrhythmias over time. OBJECTIVE To assess the incidence of symptomatic arrhythmias after initially successful AVNRT ablation and to analyze their clinical implications in a real-world cohort. METHODS We included 2,795 patients from the German Ablation Registry undergoing first ablation of AVNRT between 01/2007 and 01/2010. In patients alive at long-term follow-up, patient-specific characteristics and long-term follow-up data were compared between patients with (group A) and without (group B) any symptomatic arrhythmia during follow-up. RESULTS Symptomatic arrhythmias occurred in 17.2% of patients during a mean follow-up of 678 days after AVNRT ablation. The patients with symptomatic arrhythmias were more often female and suffered from structural heart disease. Arrhythmia occurrence was clinically relevant regarding symptoms and patient satisfaction. Serious adverse events including stroke, transient ischemic attack, pacemaker implantation, as well as continued use of antiarrhythmic medication occurred more often in group A. A second ablation procedure was performed in 26% of symptomatic patients to optimize the symptomatic outcome, whereas cardiovascular events or patient satisfaction were not further improved. CONCLUSION During long-term follow-up, one out of six patients experienced symptomatic arrhythmias after AVNRT ablation, associated with an increase of serious adverse events. A subset of patients required medical or interventional antiarrhythmic therapy, possibly attributable to the co-existence of other arrhythmias. Screening for arrhythmic and cardiac co-morbidity before and after ablation may support comprehensive therapy planning and outcome.
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14
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Increased risk of late pacemaker implantation after ablation for atrioventricular nodal reentry tachycardia: A 10-year follow-up of a nationwide cohort. Heart Rhythm 2019; 16:1182-1188. [DOI: 10.1016/j.hrthm.2019.02.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 11/20/2022]
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15
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Tachibana M, Banba K, Matsumoto K, Ohara M, Nagase S. A safe and simple approach to avoid fast junctional rhythm during ablation in patients with atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2019; 30:1578-1585. [DOI: 10.1111/jce.14045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Motomi Tachibana
- Departments of CardiologySakakibara Heart Institute of Okayama Japan
| | - Kimikazu Banba
- Departments of CardiologySakakibara Heart Institute of Okayama Japan
| | - Kensuke Matsumoto
- Departments of CardiologySakakibara Heart Institute of Okayama Japan
| | - Minako Ohara
- Departments of CardiologySakakibara Heart Institute of Okayama Japan
| | - Satoshi Nagase
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsaka Japan
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16
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Outcome of slow pathway modulation for atrioventricular nodal reentrant tachycardia with 50 versus 30 watts-more power, more effect? J Interv Card Electrophysiol 2018; 52:157-161. [PMID: 29556909 DOI: 10.1007/s10840-018-0360-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Slow pathway modulation is the treatment of choice in patients with atrioventricular nodal reentrant tachycardia (AVNRT). No comparative data on ablation strategies exist. Therefore, we sought to compare two common ablation approaches. METHODS We analyzed prospective ablation databases of two high-volume tertiary centers (> 1000 ablations/year) using either 30 or 50 W for slow pathway modulation from 2012 to 2013. We analyzed procedural characteristics as well as short- and long-term outcomes. Mean follow-up was 36 ± 9 months. RESULTS Six hundred thirty-four patients (50 W center: n = 342, 30 W center: n = 292) were ablated. Slow pathway modulation was successful in 99% in both groups (p = ns). Periprocedural AV block occurred in nine patients (2.6%) in the 50 W and five patients (1.7%) in the 30 W group (p = 0.59), respectively. We documented no permanent higher-degree AV block. The number of RF lesions and seconds of RF delivery was significantly less in the 50 W group (p = 0.04 for number of lesions; p < 0.001 for seconds). AVNRT recurrence was similar (p = 0.23). In males, significantly fewer recurrences accrued in the 50 W group (p = 0.04), while in females less transient AV blocks occurred during the procedure with 30 W (p = 0.07). CONCLUSIONS The 30 and 50 W target power approaches for slow pathway modulation are highly effective and safe. Significantly, fewer RF duration was necessary to modulate the slow pathway with higher power output (50 W). Our subgroup analysis suggests that males and females might benefit most from different modulation approaches.
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17
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Moak JP. Look and you shall find: Perils along the road after slow pathway ablation for AV nodal reentry tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:194-196. [PMID: 29266362 DOI: 10.1111/pace.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey P Moak
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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18
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Hyun MC. Radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia in children and adolescents: a single center experience. KOREAN JOURNAL OF PEDIATRICS 2017; 60:390-394. [PMID: 29302263 PMCID: PMC5752639 DOI: 10.3345/kjp.2017.60.12.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022]
Abstract
Purpose Atrioventricular nodal reentry tachycardia (AVNRT) is less common in pediatric patients than in adult patients. Thus, data for pediatric AVNRT patients are insufficient. Hence, we aimed to analyze the patient characteristics, treatment, and any recurrences in pediatric AVNRT patients. Methods We reviewed the records of 50 pediatric AVNRT patients who had undergone radiofrequency catheter ablation (RFCA) between January 1998 and December 2016 at a single regional center. The patients were aged ≤18 years. Results Among 190 pediatric patients who underwent RFCA for tachyarrhythmia, 50 (26.3%; mean age, 13.4±2.6 years) were diagnosed as having AVNRT by electrophysiological study. Twenty-five patients (25 of 50, 50%) were male. Twenty patients (20 of 50, 40%) used beta-blockers before RFCA. All patients had no structural heart disease except 1 patient with valvular aortic stenosis and coarctation of the aorta. RFCA was performed using the anatomic approach under fluoroscopic guidance. The most common successfully ablated region was the midseptal region (25 of 50, 50%). Slow pathway (SP) ablation and SP modulation were performed in 43 and 6 patients, respectively. Complication occurred in 1 patient with complete atrioventricular block. During follow-up, 6 patients had recurrence of supraventricular tachycardia, as confirmed by electrocardiography. Among them, 5 underwent successful ablation at the first procedure. In 1 patient, induction failed during the first procedure. Conclusion RFCA is safe and effective in pediatric AVNRT patients. However, further research is needed for establishing the endpoints of ablation in pediatric AVNRT patients and for identifying risk factors by evaluating data on AVNRT recurrence after RFCA.
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Affiliation(s)
- Myung Chul Hyun
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
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