Long‐Term Follow‐up of Atrioventricular Junctional Transcatheter Electrical Ablation

Abstract

Complete data concerning long-term results of transcatheter electrical ablation of the atrioventricular junction is not available. At the request of the French Cardiac Arrhythmia Working group we undertook an inquiry in October 1983. All centers potentially able to perform such procedures were asked to report their experience. Eight centers have performed one case or more, over a period of 3 years, for a total of 91 patients. The mean follow-up completed in all patients in April 1986 was 12 +/- 10 months. The procedure was indicated for a supraventricular arrhythmia resistant to a mean of 3.9 +/- 1.3 classes of antiarrhythmic agents. Atrial flutter or fibrillation in 54 (59%) and atrioventricular nodal reentry in 17 (18%) were the most common arrhythmias. A mean of 2.6 +/- 2.3 electrical shocks (range 1-14 shocks) with a stored energy of 130-400 joules was delivered during 1-5 sessions. Complete heart block was obtained in 83 patients and persisted at the time of discharge from the hospital in 46 patients (50.5%). The immediate complication (within 24 hours after the procedure) included ventricular fibrillation successfully converted (one patient) and nonsustained ventricular tachycardia (three patients). Late complications included one death 3 days after the procedure, in a patient in whom sustained ventricular tachycardia was documented, nonsustained ventricular tachycardia in two patients, sepsis in three patients and pericardial effusion in one patient. At the time of the follow-up, there were three additional deaths related to sepsis due to pacemaker pocket infection in one patient and to preexisting congestive heart failure in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

DDD(R) Pacing with Automatic Mode Switch in Patients with Paroxysmal Atrial Fibrillation following AV Nodal Ablation

“…Advanced AV block combined with paroxysmal atrial fibrillation/flutter is considered as a relative indication for AV-synchronous pacing [9], This combination is of clinical interest because of the increasing number of patients treated by AV node ablation for the treatment of paroxysmal atrial fibrillation/flutter [10][11][12], The mean age of our patient group was similar to those given in a previous report [1,2,13]. The results of these investiga tions.…”

Atrial fibrillation: current knowledge and recommendations for management*1

“…It is also used to alleviate symptoms in patients with atrial fibrillation associated with a rapid ventricular rate not controlled by drug therapy [163,164] . The initial technique for ablation of the His bundle by direct current (direct current shock ablation) has been abandoned due to complications which included cardiac perforation, tamponade, acute depression of left ventricular function, proarrhythmia and sudden death [150,[185][186][187][188][189] . Therefore, catheter ablation of the atrioventricular junction is now performed with the delivery of radiofrequency energy [190][191][192][193][194][195] .…”

Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes.

“…Complete atrioventricular block persisted in 15 of 16 patients at a mean follow-up of Since the first reports in 1982 by Scheinman et all and Gallagher et al,2 catheter-mediated k ablation of the atrioventricular junction has come into relatively frequent use in patients with drug-resistant supraventricular tachyarrhythmias. [3][4][5][6][7] The catheter-ablation technique involves the delivery of high-energy DC shocks (from a conventional defibrillator) to catheter electrodes positioned close to the junction of the atrioventricular node and His bundle. This technique is quick and effective in producing permanent complete atrioventricular block, but hemodynamic collapse, ventricular arrhythmias, and cardiac rupture have occasionally resulted.…”