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Radiofrequency Catheter Atrioventricular Node Ablation in Patients with Permanent Cardiac Pacing Systems
Author(s) -
CHANG ANTHONY C.,
McAREAVEY DOROTHEA,
TRIPODI DOROTHY,
EANANAPAZIR LAMEH
Publication year - 1994
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1994.tb01352.x
Subject(s) - medicine , ablation , cardiology , atrioventricular block , atrioventricular node , catheter ablation , atrial fibrillation , catheter , rf ablation , heart block , surgery , electrocardiography , tachycardia
Following successful BF ablation of the atrioventricular node (AVN), temporary pacing is necessary prior to insertion of a permanent pacemaker. The risks and inconvenience of temporary pacing could be avoided if a permanent pacemaker is already in place. This study reports the feasibility of RF ablation of the AVN in 27 patients (age 55 ± 17 years, 15 males) with hypertrophic cardiomyopathy and pacemakers, Indications for AVN ablation were drug refractory atrial fibrillation in 24 patients, and rapid AVN conduction preventing septal pre‐excitation by DDD pacemaker, inserted for relief of left ventricular outflow obstruction, in three cases. Sixteen patients had DDD devices and 11 patients had VVI devices. During RF ablation, each pacemaker was programmed to VVI at 50 beats/min. The ablation catheter was manipulated with fluoroscopic control to avoid close contact with or disturbance of the pacing leads. In 16 patients, RF ablation was performed immediately following pacemaker implantation but in the remaining patients, the AVN was ablated 6–32 months after pacemaker implantation. The power applied was 25–50 watts for a duration of 15–60 seconds. AV block was achieved in all cases but required 34 ± 36 applications for 16.5 ± 17.8 min/case. RF ablation consistently caused reversion to magnet rate in one patient and temporarily inhibited appropriate pacemaker discharge in another. However, no other pacemaker or lead malfunction was detected so that temporary pacing was not required in any case. At 6 ± 3 months follow‐up, all pacemakers were functioning normally without alteration in pacing parameters from baseline. Thus. RF ablation of the AVN can be performed safely in the presence of a recently implanted permanent pacemaker, without temporary pacing.