A prospective evaluation of the impact of individual RF applications for
slow pathway ablation for AVNRT: markers of acute success
Abstract
Background: Catheter ablation is highly effective for AVNRT. Generally
junctional rhythm(JR) is an accepted requirement for successful ablation
however there is a lack of detailed prospective studies to determine the
characteristics of JR and the impact on slow pathway conduction.
Methods: Multicentre prospective observational study evaluating the
impact of individual radiofrequency(RF) applications in typical
AVNRT(Slow/Fast). Characteristics of JR during ablation were documented
and detailed testing was performed after every RF application to
determine outcome. Procedural success was defined as ≤1 AV nodal echo.
Results: Sixty-seven patients were included(mean age 53±18years, 57%
female and a history of SVT 2.9±4.7years). RF(50w,60degrees) ablation
for AVNRT was applied in 301 locations with JR in 178(59%). Successful
slow pathway modification was achieved in 66(99%) patients with slow
pathway block in 30(46%). Success was associated with JR in all
patients. Success was achieved in 6 patients with RF<10
seconds. There was no significant difference in the CL of JR during RF
between effective(587±150ms) vs ineffective (611±193ms,p=0.4)
applications. Inadvertent JA-block with immediate termination of RF was
observed in 19(28%) patients with AVNRT no longer inducible in
14(74%). Freedom from SVT was achieved in 66(99%) patients at a mean
follow up of 15±6 months. Conclusion: In this prospective study, JR was
required during RF for acute success in AVNRT. Cycle length of JR during
RF was not predictive of success. Unintended JA block during faster JR
was associated with slow pathway block. RF applications as short as 10s
resulting in junctional rhythm may be successful in some patients.