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Di C, Wang Q, Wu Y, Li L, Lin W. The underrecognized and neglected compact atrioventricular nodal potential: clinical significance for preventing atrioventricular block during so-called slow pathway radiofrequency ablation. J Interv Card Electrophysiol 2024; 67:165-174. [PMID: 37330428 DOI: 10.1007/s10840-023-01597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The radiofrequency (RF) ablation target may be located at the compact atrioventricular node (AVN) region during so-called slow pathway (SP) RF ablation, potentially leading to transient or permanent atrioventricular block (AVB). However, related data are rare. METHODS Among 715 index consecutive patients who underwent RF ablation for atrioventricular nodal re-entry tachycardia, 17 patients subsequently experienced transient or permanent AVB and were included in this retrospective observational study. RESULTS Among the 17 patients, two patients (11.8%) developed transient first-degree AVB, four patients (23.5%) developed transient second-degree AVB, seven patients (41.2%) developed transient third-degree AVB, and four patients (23.5%) developed permanent third-degree AVB. During baseline sinus rhythm before the start of RF ablation, no His-bundle potential was recorded from the RF ablation catheter. During the so-called SP RF ablation that led to transient or permanent AVB, junctional rhythm with ventriculoatrial (VA) conduction block followed by subsequent AVB was observed in 14 of 17 patients (82.4%), and a low-amplitude, low-frequency hump-shaped atrial potential was recorded before the start of RF ablation in 7 of the 17 patients (41.2%). Direct AVB occurred in 3 of the 17 patients (17.6%), and a low-amplitude, low-frequency hump-shaped atrial potential was recorded before the start of RF ablation in all 3 patients. CONCLUSIONS The low-amplitude, low-frequency hump-shaped atrial potential recorded at the so-called SP region may reflect the electrogram of compact AVN activation, and RF ablation to this site heralds impending AVB even when a His-bundle potential is not recorded.
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Affiliation(s)
- Chengye Di
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Qun Wang
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Yanxi Wu
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Longlu Li
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Wenhua Lin
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China.
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.
- Cardiovascular Institute, Tianjin University, Tianjin, China.
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Chrispin J, Marine JE. Safe AVNRT ablation: Take it slow. J Cardiovasc Electrophysiol 2019; 30:1586-1587. [DOI: 10.1111/jce.14044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Chrispin
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimore Maryland
| | - Joseph E. Marine
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimore Maryland
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Impact of Radiofrequency Ablation and Antiarrhythmic Medications on the Quality of Life of Patients with Supraventricular Tachycardias: Preliminary Validation of the Greek Version of the Umea22 (U22) Questionnaire. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3059478. [PMID: 30402470 PMCID: PMC6198555 DOI: 10.1155/2018/3059478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/16/2018] [Accepted: 09/24/2018] [Indexed: 12/03/2022]
Abstract
Objective This study aims to (i) translate, culturally adapt, and preliminarily validate the arrhythmia-specific Umea22 (U22) questionnaire and (ii) assess the impact of radiofrequency (RF) ablation and medical treatment on the quality of life of patients with supraventricular tachycardias (SVTs). Methods A total of 140 patients with atrioventricular nodal re-entry tachycardia (AVNRT) and atrioventricular re-entry tachycardia (AVRT) were enrolled in the study. Of these, 100 patients underwent RF ablation (group A) and 40 patients were managed with antiarrhythmic medications (group B). Health-related quality of life (HRQoL) was assessed for both groups using the Short Form-36 Health Survey (SF-36) and the arrhythmia-specific Umea22 (U22) questionnaire at baseline and 3-month follow-up. Exploratory and confirmatory factor analyses were performed to assess the validity of the U22 questionnaire. Univariate comparisons of HRQoL scores between study timepoints and multivariate regression analyses adjusting for baseline confounders were conducted. Results The factor analysis of the U22 questionnaire yielded a six-factor model (“burden of spells”; “heart contractility”; “character of spells”; “general/non-specific feeling”; “other specific somatic symptoms”; “fear”) with acceptable fit results. Patients of group A showed significant improvement in all SF-36 and U22 scores at 3 months' follow-up compared to baseline (all p<0.05). Patients of group B presented deterioration of the total SF-36 score (p=0.001) and improvement of certain U22 measures, namely, well-being (p=0.004), heartbeat speed, and intensity during arrhythmia spells (p<0.0001 for both measures) at 3 months' follow-up, compared to baseline. Employment status, male sex, and urban residence emerged as important predictors. Conclusion The Greek version of the U22 questionnaire is a valid tool to assess SVT-related symptoms. RF ablation appears to exert more pronounced beneficial outcomes on HRQoL of patients with SVTs compared to medical treatment. Prompt referral of patients with SVTs to specialist centers may favorably affect their quality of life and should be encouraged.
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