Abstract:Background-The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately. Methods and Results-A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure o… Show more
“…The success rate for this procedure is greater than 90% for supraventricular tachycardia such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT) [1]. Radiofrequency catheter ablation (RFCA) procedures are traditionally performed under the guidance of fluoroscopy that is a highly effective way to navigate catheters and to monitor their location [2]. However, fluoroscopy requires the administration of ionizing radiation, which carries nonnegligible stochastic and deterministic effects on health for both patients and staffs [3].…”
Background: Three-dimensional electroanatomic mapping systems have demonstrated a significant reduction in radiation exposure during radiofrequency catheter ablation procedures. We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach. Methods: A multicenter prospective non-randomized registry study was performed in seven centers from January 2013 to February 2018. Consecutive patients referred for catheter ablation of supraventricular tachycardia were assigned either to a completely zero-fluoroscopic approach (ZF) or conventional fluoroscopy approach (CF) according to the operator's preference. Patients with atrial tachycardia were excluded. Results: Totally, 1020 patients were enrolled in ZF group; 2040 patients ablated by CF approach were selected for controls. There was no significant difference between the zero-fluoroscopy group and conventional fluoroscopy group as to procedure time (60.3 ± 20.3 vs. 59.7 ± 22.6 min, P = 0.90), immediate success rate of procedure (98.8% vs. 99.2%, P = 0.22), arrhythmia recurrence (0.4% vs. 0.5%, P = 0.85), total success rate of procedure (98.4% vs. 98.8%, P = 0.39) or complications (1.1% vs. 1.5%, P = 0.41). Compared with the conventional fluoroscopy approach, the zerofluoroscopy approach provided similar outcomes without compromising the safety or efficacy of the procedure. Conclusion: The completely zero-fluoroscopy approach demonstrated safety and efficacy comparable to a conventional fluoroscopy approach for catheter ablation of supraventricular tachycardia, and mitigated radiation exposure to both patients and operators.
“…The success rate for this procedure is greater than 90% for supraventricular tachycardia such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT) [1]. Radiofrequency catheter ablation (RFCA) procedures are traditionally performed under the guidance of fluoroscopy that is a highly effective way to navigate catheters and to monitor their location [2]. However, fluoroscopy requires the administration of ionizing radiation, which carries nonnegligible stochastic and deterministic effects on health for both patients and staffs [3].…”
Background: Three-dimensional electroanatomic mapping systems have demonstrated a significant reduction in radiation exposure during radiofrequency catheter ablation procedures. We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach. Methods: A multicenter prospective non-randomized registry study was performed in seven centers from January 2013 to February 2018. Consecutive patients referred for catheter ablation of supraventricular tachycardia were assigned either to a completely zero-fluoroscopic approach (ZF) or conventional fluoroscopy approach (CF) according to the operator's preference. Patients with atrial tachycardia were excluded. Results: Totally, 1020 patients were enrolled in ZF group; 2040 patients ablated by CF approach were selected for controls. There was no significant difference between the zero-fluoroscopy group and conventional fluoroscopy group as to procedure time (60.3 ± 20.3 vs. 59.7 ± 22.6 min, P = 0.90), immediate success rate of procedure (98.8% vs. 99.2%, P = 0.22), arrhythmia recurrence (0.4% vs. 0.5%, P = 0.85), total success rate of procedure (98.4% vs. 98.8%, P = 0.39) or complications (1.1% vs. 1.5%, P = 0.41). Compared with the conventional fluoroscopy approach, the zerofluoroscopy approach provided similar outcomes without compromising the safety or efficacy of the procedure. Conclusion: The completely zero-fluoroscopy approach demonstrated safety and efficacy comparable to a conventional fluoroscopy approach for catheter ablation of supraventricular tachycardia, and mitigated radiation exposure to both patients and operators.
“…Ablation of AVNRT in the context of complex congenital heart disease has previously been shown to have a high incidence of AV block. 11 In this respect, and given the lack of the usual anatomic landmarks for catheter position, cryoablation should be strongly considered. Key Teaching Points Patients with complex congenital heart disease, such as heterotaxy and especially right atrial isomerism, have a high incidence of twin atrioventricular (AV) nodes, creating a substrate for a macroreentrant tachycardia.…”
Section: Discussionmentioning
confidence: 99%
“…Ablation of AVNRT in the context of complex congenital heart disease has previously been shown to have a high incidence of AV block. 11 In this respect, and given the lack of the usual anatomic landmarks for catheter position, cryoablation should be strongly considered.…”
“…34,35 The biological risks related to X-ray exposure represent a limit for catheter ablation, especially among children and young adults, and the mapping systems help in obtaining a more precise anatomical reconstruction, particularly in children. Another advantage conferred by the mapping system is the 3D reconstruction of cardiac chambers and vessels, which can be of particular value for patients with congenital heart disease or vascular anomalies, 33,36,37 in whom this benefit can be even greater after merging the reconstruction with imaging techniques such as magnetic resonance or computed tomography. In this setting, the mapping system can help in reducing the length of the procedure and X-ray exposure, and can even improve the procedural outcome.…”
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common, highly symptomatic paroxysmal supraventricular tachycardia. Despite pharmacological treatment and vagal maneuvers for acute termination, catheter ablation has emerged as the first line treatment for the cure of AVNRT episodes. Several studies during recent years have investigated the efficacy, safety and long-term effect of both radiofrequency ablation and cryoablation of the slow pathway for the treatment of AVNRT. Innovations such as mapping systems and dedicated catheters have contributed by extending the indication to AVNRT ablation, even in particular subset populations such as children and congenital heart disease patients. We performed this review with the aim aim of summarizing and discussing current perspectives on the treatment of AVNRT, mainly focusing on catheter ablation energy sources and long-term results.
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