Author + information
- Received July 9, 2018
- Revision received August 31, 2018
- Accepted September 5, 2018
- Published online January 21, 2019.
- Demosthenes G. Katritsis, MD, PhDa,∗ (, )
- Theodoros Zografos, MDa,
- Konstantinos C. Siontis, MDb,
- George Giannopoulos, MDc,
- Rahul G. Muthalaly, MDd,
- Qiang Liu, MDe,
- Rakesh Latchamsetty, MDb,
- Zoltán Varga, MDf,
- Spyridon Deftereos, MDc,
- Charles Swerdlow, MDe,
- David J. Callans, MDf,
- John M. Miller, MDg,
- Fred Morady, MDb,
- Roy M. John, MDd and
- William G. Stevenson, MDd
- aDepartment of Cardiology, Athens Euroclinic and Hygeia Hospital, Athens, Greece
- bCardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan
- cDepartment of Cardiology, Attikon General Hospital, University of Athens Medical School, Athens, Greece
- dHeart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- eCardiology, University of California, Los Angeles, and Cedars Sinai Medical Center, Los Angeles, California
- fDepartment of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- gDepartment of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- ↵∗Address for correspondence:
Dr. Demosthenes G. Katritsis, Hygeia Hospital, 4 Erythrou Stavrou Street, Athens 15123, Greece.
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.
Dr. Zografos has received research support from AstraZeneca. Dr. Muthalaly has received research support from Avant Mutual and Monash Health. Dr. John has received lecture honoraria (modest) for educational programs from Abbott Medical and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 9, 2018.
- Revision received August 31, 2018.
- Accepted September 5, 2018.
- 2019 American College of Cardiology Foundation
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