© 2002 by European Society of Cardiology
REGULAR ARTICLES
Arrhythmia recurrences are rare when the site of radiofrequency ablation of the slow pathway is medial or anterior to the coronary sinus os
1Patras University Rio, Patras, Greece; 2Onassis Cardiac Surgery Center Athens, Greece
Manuscript submitted 16 February 2001. Accepted after revision 10 January 2002.
Correspondence: Antonis S. Manolis, MD, FESC, Professor of Cardiology, 41 Kourempana Street, Agios Dimitrios, Athens, Greece 173 43. E-mail: asm{at}otenet.gr
Key Words: Radiofrequency ablation, cardiac arrhythmias, atrioventricular nodal re-entrant tachycardia, arrhythmia recurrences, slow pathway of the atrioventricular node
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 Top Aims Methods and resultsConclusionReferences |
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The site of successful ablation of the slow atrioventricular (AV) nodal pathway may be located in the posteroseptal or midseptal area. We have previously shown that the site of successful radiofrequency (RF) ablation of the slow pathway, rather than residual slow pathway conduction correlates with AV nodal re-entrant tachycardia (AVNRT) recurrences, with more recurrences noted in inferoposterior (to the coronary sinus os) locations. Accordingly, we have since modified our approach, and in a consecutive series of 105 patients we have performed slow pathway RF ablation exclusively at medial or anterior locations, with the objective of prospectively examining the recurrence rate of AVNRT incurred with this approach.
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Methods and results |
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TopAimsMethods and resultsConclusionReferences |
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The study included 40 men and 65 women, aged 42±18 years, having RF ablation for symptomatic AVNRT exclusively in anterior to the coronary sinus os locations. A combined anatomical and electrophysiological approach to slow pathway ablation was employed. This series of patients was compared with the previous series of 55 patients (historical group) with AVNRT undergoing RF ablation at both inferoposterior and anteromedial locations.
The mean cycle length of the induced AVNRT was 329+48 ms. RF ablation was successful in all patients (100%). A mean of 7±6 lesions was applied. Persistent jump or echo beats were noted in 48 patients (46%). The procedure lasted for 2·1±1·0 h. Fluoroscopy time was 23±14 min. Procedures were complicated by heart block in two patients (1·9%). Over 26±19 months, there has been only one recurrence of AVNRT (1%). The historical group had similar age (37±18 years), gender (17 men/38 women), AVNRT cycle length (340±60 ms), number of RF lesions (9±6), or residual slow pathway conduction (42%), but longer fluoroscopy time (41±25 min) and procedure duration (4±1 h), and a significantly higher recurrence rate (seven patients/13%) (P=0·004) at a much shorter follow-up period of 12±8 months.
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Conclusion |
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TopAimsMethods and resultsConclusionReferences |
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AVNRT recurrences are rare (1%) when slow pathway RF ablation is performed in medial or anterior locations at the tricuspid annulus, rather than in inferoposterior sites, whereby a higher (13%) recurrence rate has been previously noted. Copyright 2002 The European Society of Cardiology, Published by Elsevier Science Ltd. All rights reserved.
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