| Prediction of atrioventricular block during radiofrequency ablation of the slow pathway of the atrioventricular node. | |
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MedLine Citation:
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PMID: 8521571 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Selective radiofrequency (RF) ablation of the slow pathway is an effective treatment for atrioventricular (AV) nodal reentry tachycardia. A previous report showed that rapid junctional tachycardia (JT) caused by RF associated with loss of ventriculoatrial (VA) conduction is related to increased risk for AV block. However, this can be difficult to detect during energy delivery, and more importantly, it cannot be measured before the onset of RF energy delivery. The aim of our study was to determine whether measurements made from electrograms could be used to predict the risk of AV block before RF energy is delivered. METHODS AND RESULTS: Fifty-eight patients underwent 63 selective slow pathway RF ablation procedures. In 46 (26.9%) of 172 JTs caused by RF, VA block was observed, and in 11 this was followed by AV block of various degrees. Electrograms before each application of RF were analyzed for the interval between the atrial signals in the His bundle catheter and in the distal mapping catheter [A(H)-A(Md)], the interval between the atrial signals in the His bundle catheter and in the proximal coronary sinus catheter [A(H)-A(CS)], the AV ratio, and the presence of a slow pathway potential or a fractionated atrial signal in the distal mapping catheter. Mean cycle length (CL) of JT was calculated if it consisted of at least 10 beats. These parameters were compared between patients with JT who developed VA block and subsequent AV block (group 1), patients with JT and VA block but without subsequent AV block (group 2), and patients with JT without VA block (group 3). The A(H)-A(Md) interval was significantly shorter in group 1 (17 +/- 8 ms) than in groups 2 (33 +/- 8 ms, P < .001) and 3 (32 +/- 10 ms, P < .001), whereas the A(H)-A(Md) intervals of groups 2 and 3 did not differ from each other. CL of JT, A(H)-A(CS) interval, AV ratio, presence of a slow pathway potential, or a fractionated atrial electrogram were not related to the occurrence of AV block. CONCLUSIONS: The A(H)-A(Md) interval provides an electrophysiological marker that can be used in addition to the radiological catheter position to assess the risk for AV block before onset of RF delivery. CL of JT and occurrence of VA block are not related to the risk of AV block. |
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Authors:
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F Hintringer; J Hartikainen; D W Davies; S C Heald; J S Gill; D E Ward; E Rowland |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 92 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1995 Dec |
Date Detail:
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Created Date: 1996-01-23 Completed Date: 1996-01-23 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 3490-6 Citation Subset: AIM; IM |
Affiliation:
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St George's Hospital, London, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrioventricular Node
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surgery* Cardiac Pacing, Artificial Catheter Ablation* Electrocardiography Female Heart Block / epidemiology, etiology, prevention & control* Humans Male Middle Aged Predictive Value of Tests Retrospective Studies Risk Factors Tachycardia, Atrioventricular Nodal Reentry / diagnosis, physiopathology, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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