Radiofrequency Ablation of Typical Atrioventricular Nodal Reentry Tachycardia in Dual and Multiple AV Nodal Pathways

Abd Al-Hassan Al-Alwany, Ameen

	Radiofrequency Ablation of Typical Atrioventricular Nodal Reentry Tachycardia in Dual and Multiple AV Nodal Pathways
Medical Journal of Babylon
Article 1, Volume 12, Issue 3, 2015, Pages 745-754
Author
Ameen Abd Al-Hassan Al-Alwany
Abstract
Typical atrioventricular nodal reentrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia among adults. The concept of dual pathway physiology remains widely accepted. Slow pathway (SP) ablation is the first-line treatment approach with a high acute success rate and a low risk of inadvertent complete atrioventricular (AV) block and noninduciblility consider the primary end point of ablation. Aimsof study to determine the percentage of multiple AV nodal pathways in patients with only typical AVNRTs and to compare its electrophysiological data with usual dual AV nodal pathways. The study included 40 patients with only typical AVNRT(mean age 51 ± 6.8 years, 28 (70%) women) who underwent SP ablation using anelectrophysiological and anatomical approach. Electrophysiological analysis was performed for; differentiate dual from multiple pathways and potential predictors of acute success ablation. The patients were divides into two groups according to the number AH-jump as increase by 50 ms or more which was analyses after applied atrial programmed electrical stimulation. Group I 25 (62.5%) with dual AV nodal pathway and Group II 15 (37.5%) with multiple AV nodal pathways. The tachycardia cycle length seems to be faster in Group I (345 ±65 versus 410 ±70). Acute successful ablation was achieved in all patients 100%. More radiofrequency energy applications were required in group II (14± 5.6versus 7.8± 4.6) in Group (I). In patients with more than two AV-nodal pathways Group II, thecatheter intervention resulted more frequently in a modulationof slow pathway conduction than in an ablation ofthe slow pathway 10 (25%) was modulated versus only 5 (12.5%) were ablated. While 19 (47.5%) was ablated versus 6 (15%) were modulated in Group (I). One patient (2.5%) had developed persistent first-degree (PR 250ms) and transient second-degree AV block after ablation. There is unexpectedly high percentage of typical AVNRTs (37.5%) with more than two AV nodal pathways and these require good electrophysiological evaluation for successful ablation. The slow pathway SP ablation of typical AVNRTs using radiofrequency energy is a highly effective procedure with an extremely low risk of development AV block.
Keywords
Typical AVNRT; AV node pathway and Ablation

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