Left Septal Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia

Katritsis, Demosthenes G.; John, Roy M.; Latchamsetty, Rakesh; Muthalaly, Rahul G.; Zografos, Theodoros; Katritsis, George; Stevenson, William G.; Efimov, Igor R.; Morady, Fred

doi:10.1161/circep.117.005907

Cited by 33 publications

(19 citation statements)

References 30 publications

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“…Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia successful ablation, either from the right or left septal side. [18][19][20]25 Slow pathway ablation or modification as described is effective in both typical and atypical AVNRT. 19 It is no longer necessary to create higher lesions or perform mapping during tachycardia.…”

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confidence: 99%

“…Recent reports have provided useful insights into the technique and complications associated with catheter ablation,and several myths have been refuted, outlined below. 5,[18][19][20] We know now that the inferior nodal extensions represent the anatomical substrate of the slow pathway in all forms of AVNRT. 4,[21][22][23] The only legitimate question that still remains unanswered is the relative importance of the right and left extensions.…”

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confidence: 99%

“…20 Non-inducibility of the arrhythmia, usually after ablationinduced junctional rhythm and despite isoproterenol challenge, is the most credible endpoint for success. 5,[18][19][20] This procedure can be accomplished in both typical and atypical AVNRT with no risk of AV block. We now have substantial evidence demonstrating that we can offer a radical cure for this arrhythmia without any subsequent need for permanent pacing.…”

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confidence: 99%

“…We now have substantial evidence demonstrating that we can offer a radical cure for this arrhythmia without any subsequent need for permanent pacing. 5,[18][19][20] Acute success rates as a result of rendering the tachycardia noninducible can be achieved in all patients. Recurrence rates are 2 % in typical and 5 % in atypical AVNRT.…”

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confidence: 99%

“…Recurrence rates are 2 % in typical and 5 % in atypical AVNRT. 18,19 Recurrence is usually seen within the 3 months following a successful procedure in symptomatic patients with frequent episodes of tachycardia. 20,25,29,30 However, in those aged ≤18 years, recurrence may occur up to 5 years postablation.…”

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confidence: 99%

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Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction

Katritsis

2018

Arrhythmia &Amp; Electrophysiology Review

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Although the exact circuit of atrioventricular nodal re-entrant tachycardia (AVNRT) still eludes us, AVNRT is the most common regular arrhythmia in humans, and therefore the most commonly encountered during ablation attempts for regular tachycardias. [1][2][3][4] Catheter ablation for AVNRT is the current treatment of choice in symptomatic patients. It reduces arrhythmia-related hospitalisations and costs, and substantially improves quality of life. [5][6][7][8][9][10][11][12][13][14][15][16] Catheter ablation approaches aimed at the fast pathway have been abandoned; slow pathway ablation, using a combined anatomical and mapping approach, is now the method of choice. This approach offers a success rate of 95 %, has a recurrence rate of approximately 1.3-4.0 %, and has been associated with a low risk of atrioventricular (AV) block that in most, but not all, studies is <1 %. 9,10,15,17 How true are these assumptions, however, in the current era of catheter ablation? Recent reports have provided useful insights into the technique and complications associated with catheter ablation,and several myths have been refuted, outlined below. 5,[18][19][20] We know now that the inferior nodal extensions represent the anatomical substrate of the slow pathway in all forms of AVNRT. 4,[21][22][23] The only legitimate question that still remains unanswered is the relative importance of the right and left extensions. Connexin staining and genotyping studies have identified the left inferior extension and the AV node itself as areas of low connexin 43 (Cx43) expression, and consequently slow conduction, thus suggesting that this is the main substrate of the slow pathway (Figure 1). 24 The inferior nodal extensions at the inferior (posterior) part of the triangle of Koch and below the coronary sinus ostium, as depicted in the right anterior oblique projection, are the appropriate targets for KeywordsAtrioventricular nodal re-entrant tachycardia, catheter ablation Disclosure: The author has no conflicts of interest to declare.A. Proposed circuits of AVNRT based on the role of the inferior nodal extensions. During typical AVNRT (slow-fast) right-or left-sided circuits may occur with antegrade conduction through the inferior inputs and retrograde conduction through the superior inputs or the anisotropic atrionodal transitional area. In atypical AVNRT, conduction occurs anterogradely through the left or right inferior inputs, and retrogradely through the other. Depending on the orientation of the circuit, we may record the so-called fast-slow, slow-slow, or indeterminate types. B. Hypothetical circuits of AVNRT based on connexin genotyping data. Areas in blue have a high expression of Cx43 and therefore display characteristics of fast conduction. These are the right inferior extension, and the lower nodal bundle. There is also a smooth transition in Cx43 at the interface of the transitional cells and the node. Areas in yellow, such as the compact node and the left inferior extension, have very low Cx43 expression and are capable of slow...

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confidence: 99%