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

Abstract

Isoproterenol should be used routinely after slow pathway modification, when a residual jump and/or single echo remain.

Role of Isoproterenol in Predicting the Success of Catheter Ablation in Patients with Reproducibly Inducible Atrioventricular Nodal Reentrant Tachycardia

“…On the other hand, Stern and associates, 14 in a metaanalysis, showed that the "nonuniform use of isoproterenol" (strategy 2, in our present study) would lead to a higher long-term recurrence rate of AVNRT in cases of slow-pathway modification than in cases of slow-pathway elimination. Conversely, "uniform use of isoproterenol" (strategy 1 in our present study) yielded the same recurrence rates, whether the slow pathway was modified or eliminated.…”

“…[8][9][10][11][12] However, the published data available for the comparison of these 2 strategies are inadequate. 13,14 In any event, the effectiveness of arrhythmia reproducibility in evaluating the success of AVNRT ablation has not been well defined: AVNRT inducibility is not reproducible in more than one third of cases, 15 and that failure of inducibility after ablation might sometimes indicate the absence of reproducibility, rather than the success of ablation.…”

“…[8][9][10][11][12] However, the published data available for the comparison of these 2 strategies are inadequate. 13,14 In any event, the effectiveness of arrhythmia reproducibility in evaluating the success of AVNRT ablation has not been well defined: AVNRT inducibility is not reproducible in more than one third of cases, 15 and that failure of inducibility after ablation might sometimes indicate the absence of reproducibility, rather than the success of ablation.To avoid the confounding effect of nonreproducibility, we designed this study to investigate whether the post-ablation administration of isoproterenol for reinduction of AVNRT (in patients in whom the original arrhythmia had been reproducibly inducible without the use of any provocative agent) has any effect on the long-term recurrence rate of the arrhythmia. In both strategies stated above, isoproterenolwhen necessary for arrhythmia induction before ablation-is also used to evaluate the inducibility of AVNRT after ablation.…”

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

“…Cryoablation is effective and safe, but its widespread use seems to be limited by a slightly lower long-term clinical efficacy when compared to radiofrequency (RF) ablation [1]. After an RF procedure, residual conduction through the slow pathway associated with AVNRT non-inducibility does not seem to modify long-term results [2]. Contrarily, the persistence of a residual slow pathway after cryoablation has been correlated with a higher recurrence rate [3–6].…”

Diagnosis and management of supraventricular tachycardia

“…31 A meta-analysis of 10 observational studies comprising 1204 patients reported a 4.3% recurrence rate. 32 Serious complications are uncommon, the most serious being atrioventricular block requiring pacemaker therapy (affecting 1% of patients in early series). 31 33 34 AVRT is also amenable to catheter ablation.…”