Cryothermal slow pathway modification for atrioventricular nodal reentrant tachycardia

Predictors of recurrence following transcatheter cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) are currently unknown. Our objective was to explore predictors of recurrence post-cryoablation for AVNRT, including the impact of procedural endpoints such as complete elimination of slow pathway conduction vs. persistent dual atrioventricular (AV) nodal physiology with or without echo beats.

A single center cohort study was performed on patients undergoing a first cryoablation procedure for AVNRT between May 1999 and December 2004. Cryoablation for AVNRT was attempted in 185 consecutive patients (79.2% female), age 43.1 +/- 15.2 years. Acute success was achieved in 170 (91.9%) patients with 4.4 +/- 3.5 cryoapplications and a total procedural duration of 2.8 +/- 0.8 h. Complete elimination of slow pathway conduction was noted in 47.6% of acutely successful interventions, absence of AV nodal echoes despite dual AV nodal physiology in 8.8%, and presence of echoes but no inducible AVNRT on and off isoproterenol in 43.5%. Actuarial recurrence-free survival following acutely successful cryoablation at 1, 3, 6, 12, and 24 months was 94.8, 93.1, 91.7, 90.8, and 90.8%, respectively. Independent predictors of recurrence were younger age (P = 0.0045) and valvular heart disease (P = 0.0186). The achieved procedural endpoint did not modulate recurrence rates. Eight patients (4.3%) experienced transient third degree AV block; none required permanent pacing.

As a cryoablation procedural outcome for AVNRT, persistent dual AV nodal physiology with or without echo beats is not associated with higher recurrence rates than complete elimination of dual AV nodal physiology if AVNRT remains non-inducible on and off isoproterenol.