Characteristics of Slow Pathway Conduction After Successful AVNRT Ablation

Pósán, Emőke; Gula, Lorne J.; Skanes, Allan C.; Krahn, Andrew D.; Yee, Raymond; Petrellis, Basilios; Redfearn, Damián P.; Mohamed, Uwais; Gould, Paul A.; Klein, George J.

doi:10.1111/j.1540-8167.2006.00492.x

Cited by 20 publications

(19 citation statements)

References 23 publications

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“…Recently, Posan et al [29] showed that in patients with persistent slow pathway conduction after RF ablation, but no recurrent AVNRT, slow pathway ERP increased, while the difference between the fast and slow pathway ERP was reduced, thus decreasing the induction window of reentry [30]. The same operating mechanism could be extrapolated to cryoablation.…”

Section: Discussionmentioning

confidence: 99%

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump

Tonet

Sisti

Restrepo³

et al. 2012

J Interv Card Electrophysiol

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PurposeA residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump.MethodsWe analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter. Success was defined as AVNRT non-inducibility. Patients with no baseline elicitable jump, no inducible AVNRT, and transient first atrioventricular (AV) block at the last site were excluded.ResultsFrom 371 patients who underwent cryoablation from May 2002 to March 2011, 303 fulfilled the entry criteria (mean age, 41 ± 16; 222 women). Baseline AV nodal effective refractory period (ERP) was 272 ± 57 ms, postprocedural 331 ± 64 (P < 0.001), and the mean of the difference (Δ ERP) 60 ± 41. At the end of the procedure, 64 patients (21 %) had a residual jump, of whom 22 with a single echo. At 12 months follow-up, the actuarial recurrence-free rate was 70.3 % in patients with a residual jump and 86 % in those without (P = 0.01). In patients with a jump, only Δ AV nodal ERP was correlated with recurrence (37 ± 41 vs. 68 ± 47 ms; P < 0.04) while a single echo was not. The actuarial rate of recurrence was 60.8 % in patients with a Δ AV nodal ERP ≤ 30 ms and 18.8 % in those with a Δ AV nodal ERP >30 ms (P < 0.01).ConclusionsSuppression of slow pathway conduction is the optimal endpoint for AVNRT cryoablation. A residual jump can be tolerated if AV nodal ERP postcryoablation is prolonged >30 ms.

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Section: Discussionmentioning

confidence: 99%

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump

Tonet

Sisti

Restrepo³

et al. 2012

J Interv Card Electrophysiol

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“…Recently, Posan et al demonstrated that in patients with persistent slow pathway conduction, but no recurrent AVNRT, a number of conduction property modifications occur. Slow pathway effective refractory periods increase, while the maximum slow pathway atrial‐His (AH) interval, the range of slow pathway AH intervals, and the difference between the fast and slow pathway effective refractory periods are all reduced 16 . This occurs without a significant change in the slow pathway functional refractory period.…”

Section: Discussionmentioning

confidence: 99%

“…Slow pathway effective refractory periods increase, while the maximum slow pathway atrial-His (AH) interval, the range of slow pathway AH intervals, and the difference between the fast and slow pathway effective refractory periods are all reduced. 16 This occurs without a significant change in the slow pathway functional refractory period. The authors argue that these changes prevent the induction of AVNRT because either the initial slow pathway can no longer sustain persistent 1:1 A:V conduction or the remaining conduction is via a second slow pathway that again cannot sustain persistent A:V conduction.…”

Section: Discussionmentioning

confidence: 99%

Meta‐Analysis to Assess the Appropriate Endpoint for Slow Pathway Ablation of Atrioventricular Nodal Reentrant Tachycardia

Stern

Rolnitzky

Goldberg

et al. 2010

Pacing Clinical Electrophis

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“…Our knowledge of the electrophysiological mechanisms underlying AVNRT has remained generally unchanged for many years 2,3 and the exact anatomical correlates of the mechanism remain a mystery 4 . Persistence of slow pathway conduction after ablation has been well‐documented after successful elimination of tachycardia 5–9 .…”

Section: Discussionmentioning

confidence: 99%

“…Our knowledge of the electrophysiological mechanisms underlying AVNRT has remained generally unchanged for many years 2,3 and the exact anatomical correlates of the mechanism remain a mystery. 4 Persistence of slow pathway conduction after ablation has been well-documented after successful elimination of tachycardia. [5][6][7][8][9] This case is consistent with previous evidence that elimination of slow pathway conduction is not necessary for successful AVNRT ablation.…”

Section: Discussionmentioning

confidence: 99%

One Slow Pathway or Two?

Mohamed¹,

Gula²,

Skanes³

et al. 2006

Cardiovasc electrophysiol

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CaseA 56-year-old man with a history of palpitations and documented narrow complex tachycardia was referred to our center for assessment. There was no history of heart disease and left ventricular function was normal.Electrophysiology study and ablation were performed using standard methods with the patient in the postabsortive state and under conscious sedation. Catheters were positioned in the high right atrium, right ventricular apex, coronary sinus, and His position. Baseline intervals were AH 72 msec, This manuscript was processed by a guest editor. Figure 1. AV node reentrant tachycardia initiated by atrial extrastimulus testing at drive cycle length 400 msec and coupling interval 270 msec.HV 41 msec, and QRS duration 75 msec. Atrial extrastimulus testing demonstrated a rate-dependent increase in conduction time over the AV node without a discrete "jump" to a slow AV nodal pathway. Tachycardia was initiated at drive cycle length 400 msec and coupling interval 270 msec (Fig. 1). The rhythm was AV node reentrant tachycardia (AVNRT) as determined by diagnostic pacing maneuvers. Tachycardia was reliably induced at coupling intervals 240-270 msec, and single echoes were observed at coupling intervals less than 240 msec. Slow pathway ablation was performed and extrastimulus testing was repeated. Tachycardia was no longer inducible, but single AV nodal echoes were still observed at coupling intervals less than 270 msec. AV node conduction curves before and after ablation are demonstrated in Figure 2. What do these curves suggest regarding AV node conduction properties and the impact of ablation? DiscussionInitial atrial extrastimulus testing demonstrated that conduction over the slow AV nodal pathway resulted in typical

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Characteristics of Slow Pathway Conduction After Successful AVNRT Ablation

Cited by 20 publications

References 23 publications

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump

Meta‐Analysis to Assess the Appropriate Endpoint for Slow Pathway Ablation of Atrioventricular Nodal Reentrant Tachycardia

One Slow Pathway or Two?

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