Atrioventricular Nodal Reentrant Tachycardia Treatment Using Novel Potential

Abstract

Radiofrequency ablation of atrioventricular nodal reentrant tachycardia is commonly guided by slow and sharp bipolar potentials of the atrioventricular slow nodal pathway. We optimized the morphology of the guiding potential by unipolar mapping of the slow nodal pathway. We identified a novel unipolar dual-component atrial electrogram at the anterior limb of the coronary sinus ostium. The first component was a positive delta-wave type that corresponded to the isoelectric phase on a bipolar electrogram. The second component had fast biphasic morphology and corresponded to the R wave on a bipolar atrial electrogram. Of 104 consecutive patients with typical atrioventricular nodal reentrant tachycardia, 51 were treated with ablation guided by the novel potential, and 53 underwent ablation using the conventional technique. There was no recurrence of tachycardia in any of these patients. In those treated by the novel potential, there was significantly less radiofrequency power applied and a shorter duration of application than in patients treated by the traditional approach. The novel approach to mapping and ablation of the slow nodal pathway in atrioventricular nodal reentrant tachycardia guided by unipolar recording was safe and effective, and comparable to the traditional technique.

AH jump as predictor for successful Ablation of atrioventricular nodal reentrant tachycardia (AVNRT)

“…Typical jump, contrary to no jump or multiple jumps, was such an independent variable (8). Our results showed that patients with SP modification were younger, had faster AVNRT, more often received isoproterenol after ablation, and had a higher number of applications as well as procedural time (1,7). These findings may in part be due to the fact that all operators aimed at SP ablation rather than only modification (higher number of applications and procedural duration); however, it is also possible that in patients in whom SP modification was only achieved, AVNRT characteristics were different from those in patients with complete SP elimination.…”

“…safe, data on long-term effects and predictors for success or failure ablation are incomplete. Such issues as SP ablation vs. modification or the use of isoproterenol have been addressed recently by a few studies but results are not concordant [7]. Therefore, the aim of this study was to assess and identification of a predictor for successful AVNRT ablation.…”