Conventional Atrioventricular Nodal Reentrant Tachycardia Ablation: 16-Year Acute Outcomes and Pacemaker Requirement

This study characterized the acute success, causes of failure, and index-hospitalization permanent pacemaker (PPM) rate of conventional (fluoroscopy-guided, without 3D electroanatomic mapping [3D-EAM]) AVNRT ablation over 16 years at a single center.

Consecutive adult patients (≥18 years) who underwent conventional ablation for AVNRT between January 2010 and May 2026 were retrospectively evaluated. All procedures were performed by a senior operator or under the direct supervision of a senior operator. Acute success was defined as non-inducibility of AVNRT under isoproterenol. The primary endpoints were index-hospitalization PPM and acute success. Rates are presented with Wilson 95% confidence intervals (CIs).

Of 1169 SVT cases, 814 (69.6%) underwent AVNRT ablation (age 46.9 ± 13.0 years; 67.0% female). Acute success was 90.3% (735/814; 95% CI 88.07-92.14). Causes of failure (n = 79): anatomic limitation 40 (50.6%), persistent inducibility 29 (36.7%), AV conduction disturbance 8 (10.1%), patient intolerance 1, atrial fibrillation 1. Anatomic limitation denotes ablation deliberately terminated to protect AV conduction rather than technical failure. High-grade AV block developed in 8 patients (0.98%); it resolved spontaneously in 5, and a PPM was implanted during the index hospitalization in 3 (0.37%; 95% CI 0.13-1.08). In the three PPM patients, ventricular pacing remained 100% at follow-up. Acute success showed no significant univariable association with age or sex.

Conventional AVNRT ablation can be performed at an experienced center with high success (90.3%) and a low PPM rate (0.37%). While some AV block events resolved in the laboratory, those that persisted led to a PPM requirement, and AV conduction was not regained in these patients. These findings provide operator-homogeneous real-world reference data from a tertiary referral center in Türkiye.