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AV-node isolation as an alternative to AV-node ablation in patients undergoing pace & ablate strategy.

Lisa Lemke1, Mustapha El Hamriti1, Martin Braun1

  • 1Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

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Summary

AV-node isolation (AVNI) preserves adequate escape rhythm better than AV-node ablation (AVNA) in atrial fibrillation patients. AVNI also reduces bundle branch blocks and procedural time, offering a safer alternative.

Keywords:
AV node ablationatrial fibrillationpace and ablate strategyradiofrequency ablation

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Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Devices

Background:

  • Atrioventricular (AV)-node ablation (AVNA) is a standard treatment for rate control in permanent atrial fibrillation (AF).
  • A potential limitation of AVNA is the risk of disrupting the heart's natural escape rhythm.
  • AV-node isolation (AVNI) is an alternative technique aiming to ablate the AV node region more precisely.

Purpose of the Study:

  • To compare the efficacy of AV-node isolation (AVNI) versus conventional AV-node ablation (AVNA) in preserving an adequate escape rhythm.
  • To evaluate differences in QRS width, incidence of bundle branch blocks, and procedural parameters between AVNI and AVNA.

Main Methods:

  • Retrospective study comparing 20 patients undergoing AVNI with 40 historical AVNA controls for therapy-refractory AF.
  • AVNI utilized a 3D mapping system to precisely isolate the AV node region.
  • Comparison focused on escape rhythm rates, QRS duration changes, and procedural data.

Main Results:

  • AVNI demonstrated a significantly higher rate of adequate escape rhythm post-procedure (90% vs. 40%) and during follow-up (77% vs. 36%) compared to AVNA.
  • AVNI resulted in no significant change in QRS width (0 ms) and zero new bundle branch blocks, unlike AVNA (+26 ms, 30% new blocks).
  • AVNI procedures showed significantly reduced fluoroscopy time and radiation dose.

Conclusions:

  • AV-node isolation (AVNI) is a feasible and effective alternative to conventional AVNA for managing permanent atrial fibrillation.
  • Precise radiofrequency lesion application during AVNI effectively preserves a stable AV-junctional rhythm.
  • AVNI offers improved safety by minimizing risks of bundle branch blocks and reducing procedural radiation exposure.