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Control of refractory supraventricular arrhythmias after unsuccessful closed-chest His bundle ablation
Insights
Attempted His bundle ablation for supraventricular tachyarrhythmias controlled symptoms in all patients. Preserving atrioventricular conduction did not lead to arrhythmia recurrence and may avoid permanent pacing.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Refractory supraventricular tachyarrhythmias pose a treatment challenge.
- Catheter ablation of the His bundle is an option for managing these arrhythmias.
Purpose of the Study:
- To evaluate the efficacy and safety of attempted His bundle ablation for refractory supraventricular tachyarrhythmias.
- To assess the impact of preserving atrioventricular conduction on arrhythmia recurrence and the need for pacing.
Main Methods:
- Six patients with refractory supraventricular tachyarrhythmias underwent attempted catheter ablation of the His bundle.
- Follow-up included assessment of arrhythmia status, medication use, and need for pacing.
Main Results:
- Successful permanent complete heart block was achieved in three of six patients.
- All six patients remained asymptomatic without antiarrhythmic medications during a mean 10-month follow-up.
- No major complications occurred; mild creatine kinase elevation in three patients.
- Resumption of atrioventricular conduction was not associated with symptomatic arrhythmia recurrence.
Conclusions:
- Attempted His bundle ablation can effectively control supraventricular tachyarrhythmias.
- Preservation of atrioventricular conduction following the procedure is feasible and does not preclude symptom control.
- Maintaining atrioventricular conduction may eliminate the need for permanent ventricular pacing.
Abstract:
Six patients underwent attempted catheter ablation of the His bundle for control of refractory supraventricular tachyarrhythmias. Permanent complete heart block was achieved in only three patients. All six patients have remained asymptomatic without antiarrhythmic medications over a follow-up period of six to 17 months (mean 10 months). There were no complications of the procedure apart from mild elevation of creatine kinase levels in three patients. In this series, resumption of atrioventricular (AV) conduction following attempted His bundle ablation was not associated with recurrence of symptomatic arrhythmias. Preservation of AV conduction may also obviate the need for permanent ventricular pacing.