Demosthenes G Katritsis1, Theodoros Zografos2, Konstantinos C Siontis3, George Giannopoulos4, Rahul G Muthalaly5, Qiang Liu6, Rakesh Latchamsetty3, Zoltán Varga7, Spyridon Deftereos4, Charles Swerdlow6, David J Callans7, John M Miller8, Fred Morady3, Roy M John5, William G Stevenson5. 1. Department of Cardiology, Athens Euroclinic and Hygeia Hospital, Athens, Greece. Electronic address: dkatrits@dgkatritsis.gr. 2. Department of Cardiology, Athens Euroclinic and Hygeia Hospital, Athens, Greece. 3. Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan. 4. Department of Cardiology, Attikon General Hospital, University of Athens Medical School, Athens, Greece. 5. Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 6. Cardiology, University of California, Los Angeles, and Cedars Sinai Medical Center, Los Angeles, California. 7. Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania. 8. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Abstract
OBJECTIVES: This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). BACKGROUND: Published data are conflicting. METHODS: The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. RESULTS: Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). CONCLUSIONS: Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.
OBJECTIVES: This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). BACKGROUND: Published data are conflicting. METHODS: The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. RESULTS: Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). CONCLUSIONS: Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.
Authors: Andrew Grace; Hugh Calkins; Ken Ellenbogen; Pier D Lambiase; Gregory Yh Lip; Sanjiv M Narayan; Demosthenes G Katritsis Journal: Arrhythm Electrophysiol Rev Date: 2020-06-03
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Authors: Anna M E Noten; Janneke A E Kammeraad; Nawin L Ramdat Misier; Sip Wijchers; Ingrid M van Beynum; Michiel Dalinghaus; Thomas B Krasemann; Sing-Chien Yap; Natasja M S de Groot; Tamas Szili-Torok Journal: Int J Cardiol Heart Vasc Date: 2021-10-01
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