Catheter atrioventricular junctional ablation in patients with accessory pathways

Area of Science:

• Electrophysiology
• Cardiology
• Interventional Cardiology

Background:

• Symptomatic atrioventricular reciprocating tachycardia (AVRT) associated with accessory pathways poses a treatment challenge.
• Patients often fail multiple antiarrhythmic drugs and may have failed previous ablation attempts.
• Atrioventricular junction (AVJ) ablation offers a potential therapeutic strategy for refractory AVRT.

Purpose of the Study:

• To evaluate the efficacy and outcomes of catheter ablation of the AVJ in patients with symptomatic accessory pathways and AVRT.
• To assess the long-term control of tachycardia and the incidence of new arrhythmias following AVJ ablation.

Main Methods:

• Seven patients with accessory pathways and symptomatic AVRT underwent catheter ablation targeting the AVJ.
• Patient characteristics included Wolff-Parkinson-White syndrome, concealed accessory pathways, and nodoventricular connections.
• Follow-up included assessment for tachycardia recurrence, need for antiarrhythmic therapy, and development of other arrhythmias.

Main Results:

• Chronic interruption of atrioventricular node-His conduction was achieved in all seven patients.
• Four patients remained asymptomatic without antiarrhythmic therapy at a mean follow-up of 21 months.
• New-onset atrial arrhythmias (atrial fibrillation, flutter, tachycardia) were observed in three patients, with two requiring antiarrhythmic therapy.

Conclusions:

• Atrioventricular junctional ablation is an effective strategy for controlling symptomatic atrioventricular reciprocating tachycardia in patients with accessory pathways, avoiding surgical intervention.
• A significant incidence of new atrial arrhythmias requiring management was noted post-ablation, highlighting the need for careful monitoring.