TY - JOUR
T1 - Current management and clinical outcomes for catheter ablation of atrioventricular nodal re-entrant tachycardia
AU - Chrispin, Jonathan
AU - Misra, Satish
AU - Marine, Joseph E.
AU - Rickard, John
AU - Barth, Andreas
AU - Kolandaivelu, Aravindan
AU - Ashikaga, Hiroshi
AU - Tandri, Harikrishna
AU - Spragg, David D.
AU - Crosson, Jane
AU - Berger, Ronald D.
AU - Tomaselli, Gordon
AU - Calkins, Hugh
AU - Sinha, Sunil K.
N1 - Publisher Copyright:
© Author 2017. All rights reserved.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Aims Historical studies of ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) have shown high long-term success rates and low complication rates. The potential impact of several recent practice trends has not been described. This study aims to characterize recent clinical practice trends in AVNRT ablation and their associated success rates and complications. Methods and results Patients undergoing initial ablation of AVNRT between 1 July 2005 and 30 June 2015 were included in this study. Patient demographics and procedural data were abstracted from procedure reports. Follow-up data, including AVNRT recurrence and complications, was evaluated through electronic medical record review. In total, 877 patients underwent catheter ablation for AVNRT. By the last recorded year, three-dimension (3D) electroanatomical mapping (EAM) was used in 36.2%, 43.2% included anaesthesia, and 23.1% utilized irrigated catheters. Long-term procedural success was 95.5%. The use of anaesthesia, 3D EAM, and irrigated ablation catheters were not associated with differences in success. The presence of an atrial 'echo' or 'AH' jump at the end of an acutely successful procedure was not associated with long-term recurrence (P = 0.18, P = 0.15, respectively). Complications, including AV block requiring a pacemaker (0.4%), were uncommon. Conclusion In a large, contemporary cohort, catheter ablation for AVNRT remains highly successful with low complications rates. The increased use of anaesthesia as well as modern mapping and ablation tools were not associated with changes in clinical outcomes. Further prospective evaluation of such contemporary practices is warranted given the lack of evidence to support their escalating use.
AB - Aims Historical studies of ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) have shown high long-term success rates and low complication rates. The potential impact of several recent practice trends has not been described. This study aims to characterize recent clinical practice trends in AVNRT ablation and their associated success rates and complications. Methods and results Patients undergoing initial ablation of AVNRT between 1 July 2005 and 30 June 2015 were included in this study. Patient demographics and procedural data were abstracted from procedure reports. Follow-up data, including AVNRT recurrence and complications, was evaluated through electronic medical record review. In total, 877 patients underwent catheter ablation for AVNRT. By the last recorded year, three-dimension (3D) electroanatomical mapping (EAM) was used in 36.2%, 43.2% included anaesthesia, and 23.1% utilized irrigated catheters. Long-term procedural success was 95.5%. The use of anaesthesia, 3D EAM, and irrigated ablation catheters were not associated with differences in success. The presence of an atrial 'echo' or 'AH' jump at the end of an acutely successful procedure was not associated with long-term recurrence (P = 0.18, P = 0.15, respectively). Complications, including AV block requiring a pacemaker (0.4%), were uncommon. Conclusion In a large, contemporary cohort, catheter ablation for AVNRT remains highly successful with low complications rates. The increased use of anaesthesia as well as modern mapping and ablation tools were not associated with changes in clinical outcomes. Further prospective evaluation of such contemporary practices is warranted given the lack of evidence to support their escalating use.
KW - Atrioventricular nodal re-entrant tachycardia
KW - Catheter ablation
KW - Complications
KW - Dual AV nodal physiology
KW - Long-term success
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U2 - 10.1093/europace/eux110
DO - 10.1093/europace/eux110
M3 - Article
C2 - 28541507
AN - SCOPUS:85045893198
SN - 1099-5129
VL - 20
SP - e51-e59
JO - Europace
JF - Europace
IS - 4
ER -