Tags

Type your tag names separated by a space and hit enter

Predictors of acute and long-term success of slow pathway ablation for atrioventricular nodal reentrant tachycardia: a single center series of 1,419 consecutive patients.
Pacing Clin Electrophysiol. 2011 Aug; 34(8):927-33.PC

Abstract

BACKGROUND

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common mechanism of supraventricular tachycardia. Slow pathway (SP) ablation is the first-line treatment approach with a high acute success rate and a low risk of inadvertent complete atrioventricular (AV) block. However, there is still some uncertainty as to the most appropriate procedural endpoints and the impact of these on risk of recurrence. We report the acute and long-term results of SP ablation in a large single-center consecutive series and analyze predictors of acute success and late recurrence.

METHODS

The study included 1,448 consecutive procedures in 1,419 patients with AVNRT (mean age 49 ± 17 years, 66% women) who underwent SP ablation using a combined electrophysiologic and anatomic approach. Univariate and multivariate analysis was performed for potential predictors of acute success and late recurrence.

RESULTS

Acute success was achieved in 98.1%. Transient (first, second, or third degree) AV block occurred during the procedure in 20 (1.41%) patients. One patient (0.07%) had persistent first-degree and transient second-degree AV block after ablation and underwent pacemaker implant at day 21. Of the 1,391 patients with successful ablation, 22 patients (1.5%) developed AVNRT recurrence during a follow-up period of 63 ± 38 months. The only independent predictor of reduced procedural success was the presence of atypical AVNRT (hazard ratio 3.1, P = 0.04). Independent predictors of AVNRT recurrence were age <20 years and female gender (hazard ratios 14.1 and 3.7, respectively). No significant difference in the incidence of late recurrence was observed in patients with or without residual slow-pathway conduction, or according to use of isoproterenol testing or general anesthesia. However, patients with a single echo with recurrence had a significantly larger echo window (median 85 ms) than those without (median 30 ms, P = 0.01).

CONCLUSIONS

This study demonstrates in a large consecutive single-center series that SP ablation using radiofrequency energy is a highly effective procedure with an extremely low risk of inadvertent AV block and a low recurrence rate. We found that single-AV nodal echo beats represented a procedural endpoint that did not predict AVNRT recurrence but that a large echo window is associated with recurrence. Recurrence rates in this series were higher in young women, possibly reflecting a more conservative approach to ablation in this age group.

Authors+Show Affiliations

Department of Cardiology, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21569056

Citation

Feldman, Alexander, et al. "Predictors of Acute and Long-term Success of Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia: a Single Center Series of 1,419 Consecutive Patients." Pacing and Clinical Electrophysiology : PACE, vol. 34, no. 8, 2011, pp. 927-33.
Feldman A, Voskoboinik A, Kumar S, et al. Predictors of acute and long-term success of slow pathway ablation for atrioventricular nodal reentrant tachycardia: a single center series of 1,419 consecutive patients. Pacing Clin Electrophysiol. 2011;34(8):927-33.
Feldman, A., Voskoboinik, A., Kumar, S., Spence, S., Morton, J. B., Kistler, P. M., Sparks, P. B., Vohra, J. K., & Kalman, J. M. (2011). Predictors of acute and long-term success of slow pathway ablation for atrioventricular nodal reentrant tachycardia: a single center series of 1,419 consecutive patients. Pacing and Clinical Electrophysiology : PACE, 34(8), 927-33. https://doi.org/10.1111/j.1540-8159.2011.03092.x
Feldman A, et al. Predictors of Acute and Long-term Success of Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia: a Single Center Series of 1,419 Consecutive Patients. Pacing Clin Electrophysiol. 2011;34(8):927-33. PubMed PMID: 21569056.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of acute and long-term success of slow pathway ablation for atrioventricular nodal reentrant tachycardia: a single center series of 1,419 consecutive patients. AU - Feldman,Alexander, AU - Voskoboinik,Aleksandr, AU - Kumar,Saurabh, AU - Spence,Steven, AU - Morton,Joseph B, AU - Kistler,Peter M, AU - Sparks,Paul B, AU - Vohra,Jitendra K, AU - Kalman,Jonathan M, Y1 - 2011/05/13/ PY - 2011/5/17/entrez PY - 2011/5/17/pubmed PY - 2011/12/20/medline SP - 927 EP - 33 JF - Pacing and clinical electrophysiology : PACE JO - Pacing Clin Electrophysiol VL - 34 IS - 8 N2 - BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common mechanism of supraventricular tachycardia. Slow pathway (SP) ablation is the first-line treatment approach with a high acute success rate and a low risk of inadvertent complete atrioventricular (AV) block. However, there is still some uncertainty as to the most appropriate procedural endpoints and the impact of these on risk of recurrence. We report the acute and long-term results of SP ablation in a large single-center consecutive series and analyze predictors of acute success and late recurrence. METHODS: The study included 1,448 consecutive procedures in 1,419 patients with AVNRT (mean age 49 ± 17 years, 66% women) who underwent SP ablation using a combined electrophysiologic and anatomic approach. Univariate and multivariate analysis was performed for potential predictors of acute success and late recurrence. RESULTS: Acute success was achieved in 98.1%. Transient (first, second, or third degree) AV block occurred during the procedure in 20 (1.41%) patients. One patient (0.07%) had persistent first-degree and transient second-degree AV block after ablation and underwent pacemaker implant at day 21. Of the 1,391 patients with successful ablation, 22 patients (1.5%) developed AVNRT recurrence during a follow-up period of 63 ± 38 months. The only independent predictor of reduced procedural success was the presence of atypical AVNRT (hazard ratio 3.1, P = 0.04). Independent predictors of AVNRT recurrence were age <20 years and female gender (hazard ratios 14.1 and 3.7, respectively). No significant difference in the incidence of late recurrence was observed in patients with or without residual slow-pathway conduction, or according to use of isoproterenol testing or general anesthesia. However, patients with a single echo with recurrence had a significantly larger echo window (median 85 ms) than those without (median 30 ms, P = 0.01). CONCLUSIONS: This study demonstrates in a large consecutive single-center series that SP ablation using radiofrequency energy is a highly effective procedure with an extremely low risk of inadvertent AV block and a low recurrence rate. We found that single-AV nodal echo beats represented a procedural endpoint that did not predict AVNRT recurrence but that a large echo window is associated with recurrence. Recurrence rates in this series were higher in young women, possibly reflecting a more conservative approach to ablation in this age group. SN - 1540-8159 UR - https://www.unboundmedicine.com/medline/citation/21569056/Predictors_of_acute_and_long_term_success_of_slow_pathway_ablation_for_atrioventricular_nodal_reentrant_tachycardia:_a_single_center_series_of_1419_consecutive_patients_ L2 - https://doi.org/10.1111/j.1540-8159.2011.03092.x DB - PRIME DP - Unbound Medicine ER -