Effect of residual slow pathway function on the time course of recurrences of atrioventricular nodal reentrant tachycardia after radiofrequency ablation of the slow pathway

Hummel, John D.; Strickberger, S. Adam; Williamson, Brian D.; Man, K. Ching; Daoud, Emile G.; Niebauer, Mark; Bakr, Omar; Morady, Fred

doi:10.1016/s0002-9149(99)80634-1

Cited by 35 publications

(13 citation statements)

References 9 publications

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“…[1][2][3][4][5][6][7][8][9][10][11] In the present study, late clinical AVNRT recurrence was observed in 10 of 129 patients (7.8%), therefore being able to predict the recurrence of AVNRT after the ablation procedure is important. Some investigators have suggested that complete elimination of SP conduction is a desirable goal, 1 but there are cases of broad SP and sometimes it may be difficult to achieve this end-point.…”

Section: End-point Of the Sp Ablation Proceduresmentioning

confidence: 93%

“…3 Concerning the relationship between residual SP and AVNRT recurrence, some investigators who have used ISP after ablation have suggested that residual SP is not a risk factor for recurrence. [5][6][7][8][9][10][11] Others who have used ISP or atropine after ablation agree that it is a risk factor. [2][3][4] Therefore, general consensus on the risk factors for AVNRT recurrence has not been established.…”

Section: Electrophysiologic Parameters For Predicting Avnrt Recurrencementioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] Several investigators have reported that some electrophysiologic parameters at the time of the first session of SP ablation (eg, residual SP, [1][2][3][4] residual single echo beat 2,4 and no junctional beats during ablation 2 ) may be useful for predicting the recurrence of AVNRT, but general consensus has not yet been established. In the present study, several electrophysiologic parameters at the time of SP ablation in cases of AVNRT, especially the changes in the conduction patterns through the atrioventricular node (AVN), were evaluated and compared with the presence of clinical AVNRT recurrence.…”

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confidence: 99%

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Prediction of Clinical Recurrence of Atrioventricular-Nodal Reentrant Tachycardia (AVNRT) After Successful Slow Pathway Ablation

Hara

Niwano

Yoshida

et al. 2004

Circ J

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Background Even after successful slow pathway (SP) ablation for atrioventricular-nodal reentrant tachycardia (AVNRT), there may be clinical recurrence in certain patients and it is clinically important to be able to predict that. Methods and ResultsIn 97 patients with common type AVNRT, the effective refractory period (ERP) of the fast pathway (FP), SP-ERP, and prolongation of the atrio-His (AH) interval (∆AH) at the time of jump-up phenomenon were investigated. In patients with residual SP, parameters were re-evaluated in a similar manner. SP was successfully ablated and AVNRT was not inducible in all the patients, but residual SP was observed in 54 of the 97 patients, and there was late clinical recurrence in 10 patients (10/54 patients with residual SP and 0/43 without residual SP, p=0.002). The changes in FP-ERP before and after ablation (∆FP-ERP) did not differ between recurrent and non-recurrent patients. Among the patients with residual SP, ∆SP-ERP did not differ between the groups. However, the changes in ∆AH before and after ablation (∆∆AH) were larger in non-recurrent (24±30 ms) than in the recurrent patients (4±7 ms, p=0.042). Conclusions In patients with AVNRT, the residual SP and changes in ∆AH after successful SP ablation might be useful indices of clinical recurrence. (Circ J 2004; 68: 558 -562)

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Section: End-point Of the Sp Ablation Proceduresmentioning

confidence: 93%

Section: Electrophysiologic Parameters For Predicting Avnrt Recurrencementioning

confidence: 99%

mentioning

confidence: 99%

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Prediction of Clinical Recurrence of Atrioventricular-Nodal Reentrant Tachycardia (AVNRT) After Successful Slow Pathway Ablation

Hara

Niwano

Yoshida

et al. 2004

Circ J

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“…Radiofrequency energy is applied until junctional ectopics appear, but at times successful slow pathway ablation may result without eliciting the junctional ectopic complexes. Final testing involves proof that either the slow pathway has been eliminated or that no more than one AV nodal echo is present 43,47 …”

Section: Catheter Ablation Of Avnrtmentioning

confidence: 99%

The History of AV Nodal Reentry

Scheinman

Yang

2005

Pacing Clinical Electrophis

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Though patients with AV nodal reentry are now routinely cured by catheter ablation, the basic mechanism of this disorder is still under debate. The putative mechanism of AV node reentry was first discovered by the elegant work of Gordon Moe. He demonstrated the existence of dual pathways and echo beats in rabbits. Building on these seminal observations, the mechanism of AVNRT has burgeoned to include the possibility of left atrial input into the node. The first curative nonpharmacologic procedures involved surgical dissection around the AV node and the procedure was rapidly supplanted by catheter ablation procedures. The initial ablative procedure targeted the fast pathway, but later observations showed that ablation of the slow pathway was more effective and safer. Cure of AV nodal reentry which is the most common cause of paroxysmal supraventricular tachycardia became possible through the cooperative efforts of anatomists, physiologists, surgeons, and clinical electrophysiologists.

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“…In patients with diseased conduction tissue, complete elimination of the functional slow pathway should not be vigorously pursued, and this should even be extended to patients with normal PR intervals. There is abundant clinical evidence that residual slow pathway conduction does not predict recurrence of atrioventricular nodal reentrant tachycardia as long as no more than a single atrioventricular nodal echo is accepted during isoproterenol infusion [13][14][15][16] . The risk of complications, including late occurrence of atrioventricular block, may in fact be related to the cumulative effect of the energy employed during the procedure.…”

Section: See Page 89 For the Article To Which This Editorial Refersmentioning

confidence: 99%

'Slow pathway' ablation in patients with atrioventricular nodal reentrant tachycardia: do we understand what we are doing?

Loh

Breithardt

2001

European Heart Journal

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Effect of residual slow pathway function on the time course of recurrences of atrioventricular nodal reentrant tachycardia after radiofrequency ablation of the slow pathway

Cited by 35 publications

References 9 publications

Prediction of Clinical Recurrence of Atrioventricular-Nodal Reentrant Tachycardia (AVNRT) After Successful Slow Pathway Ablation

Prediction of Clinical Recurrence of Atrioventricular-Nodal Reentrant Tachycardia (AVNRT) After Successful Slow Pathway Ablation

The History of AV Nodal Reentry

'Slow pathway' ablation in patients with atrioventricular nodal reentrant tachycardia: do we understand what we are doing?

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