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Ablation for atrioventricular nodal reentrant tachycardia with a prolonged PR interval during sinus rhythm: the risk of delayed higher-degree atrioventricular block.
J Cardiovasc Electrophysiol. 2006 Sep; 17(9):973-9.JC

Abstract

INTRODUCTION

Delayed higher-degree atrioventricular (AV) block can develop after slow pathway ablation for AV nodal reentrant tachycardia with a preexisting first-degree AV block. Retrograde fast pathway ablation is considered as an alternative approach for patients with a markedly prolonged PR interval and no demonstrable anterograde fast pathway function at baseline. This study aimed to determine the long-term reliability of AV conduction after retrograde fast pathway ablation in comparison to slow pathway ablation in patients with AV nodal reentrant tachycardia and a first-degree AV block at baseline.

METHODS AND RESULTS

Among 43 patients with AV nodal reentrant tachycardia and a prolonged PR interval (defined as >or=200 msec), 10 patients without demonstrable dual pathway physiology underwent ablation of the retrograde fast pathway, and 33 patients with dual pathway physiology underwent slow pathway ablation. Persisting intraprocedural second- or third-degree AV block requiring pacemaker implantation occurred in one patient (10%) after retrograde fast pathway ablation and in one patient (3%) after slow pathway ablation. During the long-term follow-up of 61 +/- 39 months after retrograde fast pathway ablation, no delayed second- or third-degree AV block occurred, and the PR interval remained unchanged (308 +/- 60 msec vs 304 +/- 52 msec). During the follow-up of 37 +/- 25 months after slow pathway ablation, a delayed complete heart block developed in two patients, and a second-degree AV block developed in two patients. Three patients aged 66, 75, and 76 years died suddenly of unknown cause 4, 16, and 48 months following slow pathway ablation, respectively.

CONCLUSIONS

Slow pathway ablation was associated with a significant risk of a delayed higher-degree AV block in patients with AV nodal reentrant tachycardia and a prolonged PR interval at baseline. Retrograde fast pathway ablation for patients with a first-degree AV block and no demonstrable dual pathway physiology was associated with a higher intraprocedural risk of complete AV block but did not result in the development of higher-degree AV block during the long-term follow-up of up to 9 years.

Authors+Show Affiliations

Medizinische Klinik I, Klinikum Grosshadern, Universität München, Germany. christopher.reithmann@med.uni-muenchen.deNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16800857

Citation

Reithmann, Christopher, et al. "Ablation for Atrioventricular Nodal Reentrant Tachycardia With a Prolonged PR Interval During Sinus Rhythm: the Risk of Delayed Higher-degree Atrioventricular Block." Journal of Cardiovascular Electrophysiology, vol. 17, no. 9, 2006, pp. 973-9.
Reithmann C, Remp T, Oversohl N, et al. Ablation for atrioventricular nodal reentrant tachycardia with a prolonged PR interval during sinus rhythm: the risk of delayed higher-degree atrioventricular block. J Cardiovasc Electrophysiol. 2006;17(9):973-9.
Reithmann, C., Remp, T., Oversohl, N., & Steinbeck, G. (2006). Ablation for atrioventricular nodal reentrant tachycardia with a prolonged PR interval during sinus rhythm: the risk of delayed higher-degree atrioventricular block. Journal of Cardiovascular Electrophysiology, 17(9), 973-9.
Reithmann C, et al. Ablation for Atrioventricular Nodal Reentrant Tachycardia With a Prolonged PR Interval During Sinus Rhythm: the Risk of Delayed Higher-degree Atrioventricular Block. J Cardiovasc Electrophysiol. 2006;17(9):973-9. PubMed PMID: 16800857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ablation for atrioventricular nodal reentrant tachycardia with a prolonged PR interval during sinus rhythm: the risk of delayed higher-degree atrioventricular block. AU - Reithmann,Christopher, AU - Remp,Thomas, AU - Oversohl,Nico, AU - Steinbeck,Gerhard, Y1 - 2006/06/27/ PY - 2006/6/28/pubmed PY - 2006/11/15/medline PY - 2006/6/28/entrez SP - 973 EP - 9 JF - Journal of cardiovascular electrophysiology JO - J. Cardiovasc. Electrophysiol. VL - 17 IS - 9 N2 - INTRODUCTION: Delayed higher-degree atrioventricular (AV) block can develop after slow pathway ablation for AV nodal reentrant tachycardia with a preexisting first-degree AV block. Retrograde fast pathway ablation is considered as an alternative approach for patients with a markedly prolonged PR interval and no demonstrable anterograde fast pathway function at baseline. This study aimed to determine the long-term reliability of AV conduction after retrograde fast pathway ablation in comparison to slow pathway ablation in patients with AV nodal reentrant tachycardia and a first-degree AV block at baseline. METHODS AND RESULTS: Among 43 patients with AV nodal reentrant tachycardia and a prolonged PR interval (defined as >or=200 msec), 10 patients without demonstrable dual pathway physiology underwent ablation of the retrograde fast pathway, and 33 patients with dual pathway physiology underwent slow pathway ablation. Persisting intraprocedural second- or third-degree AV block requiring pacemaker implantation occurred in one patient (10%) after retrograde fast pathway ablation and in one patient (3%) after slow pathway ablation. During the long-term follow-up of 61 +/- 39 months after retrograde fast pathway ablation, no delayed second- or third-degree AV block occurred, and the PR interval remained unchanged (308 +/- 60 msec vs 304 +/- 52 msec). During the follow-up of 37 +/- 25 months after slow pathway ablation, a delayed complete heart block developed in two patients, and a second-degree AV block developed in two patients. Three patients aged 66, 75, and 76 years died suddenly of unknown cause 4, 16, and 48 months following slow pathway ablation, respectively. CONCLUSIONS: Slow pathway ablation was associated with a significant risk of a delayed higher-degree AV block in patients with AV nodal reentrant tachycardia and a prolonged PR interval at baseline. Retrograde fast pathway ablation for patients with a first-degree AV block and no demonstrable dual pathway physiology was associated with a higher intraprocedural risk of complete AV block but did not result in the development of higher-degree AV block during the long-term follow-up of up to 9 years. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/16800857/Ablation_for_atrioventricular_nodal_reentrant_tachycardia_with_a_prolonged_PR_interval_during_sinus_rhythm:_the_risk_of_delayed_higher_degree_atrioventricular_block_ L2 - https://doi.org/10.1111/j.1540-8167.2006.00537.x DB - PRIME DP - Unbound Medicine ER -