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Should fast pathway ablation be reconsidered in typical atrioventricular nodal re‐entrant tachycardia?
Author(s) -
Tuohy Stephen,
Trulock Kevin M.,
Wiggins Newton B.,
Bassiouny Mohammed,
Ono Maki,
Kiehl Eric L.,
Cantillon Daniel,
Tarakji Khaldoun,
Tanaka Christine,
Dresing Thomas,
Saliba Walid,
Varma Niraj,
Tchou Patrick
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14012
Subject(s) - medicine , ablation , nodal , tachycardia , catheter ablation , cardiology , nodal signaling , intracardiac injection , electrophysiology study , radiofrequency ablation , accessory pathway , sinus rhythm , atrial fibrillation , gastrulation , biochemistry , chemistry , embryonic stem cell , gene
Atrioventricular nodal re‐entry tachycardia (AVNRT) is the most common, regular narrow‐complex tachycardia. The established treatment is catheter ablation of the AV nodal slow pathway (SP). However, in a select group of patients with long PR intervals in sinus rhythm, SP ablation can lead to AV block due to the absence of robust anterograde conduction through the fast pathway (FP). This report aims to demonstrate that AV nodal FP ablation is a reasonable approach in patients with AVNRT and poor or absent anterograde FP conduction. Methods and Results Standard electrophysiology study techniques were used in the electrophysiology laboratory. Catheter ablations were performed using radiofrequency energy. Mapping of intracardiac activation was performed with electroanatomical mapping systems. Outcomes were assessed acutely during the procedure and during routine clinical follow‐up. Six patients with first‐degree AV block and recurrent AVNRT who underwent ablation of their tachycardia at our institution are presented. One patient underwent ablation of AV nodal SP resulting in high‐degree AV block necessitating pacemaker implantation. The remaining five patients underwent ablation of the AV nodal FP guided by electroanatomical mapping of the earliest atrial activation in tachycardia. These five had successful treatment of the tachycardia with preservation of anterograde AV nodal conduction. Mapping and ablation approach to eliminate retrograde FP conduction are described. Conclusion In select patients with AVNRT and poor anterograde FP conduction, retrograde FP ablation is reasonable and is less likely to result in AV block and pacemaker dependency.