Document Detail


Transient proarrhythmic state following atrioventricular junction radiofrequency ablation: pathophysiologic mechanisms and recommendations for management.
MedLine Citation:
PMID:  12459407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The induction of complete heart block by radiofrequency ablation of the atrioventricular junction combined with pacemaker implantation has become an established therapy for rate control in patients with atrial fibrillation who are unresponsive to drugs. Reports of ventricular arrhythmias and sudden death after ablation have, however, raised concerns about safety. Ventricular arrhythmias are usually polymorphic and related to a phase of electrical instability due to an initial prolongation and then slow adaptation of repolarization caused by the change in heart rate and activation sequence. Structural heart disease, and other factors that predispose for the acquired long QT syndrome, seem to add to the risk. Ventricular activation and repolarization stabilize during the first week after the procedure. Routine pacing at 80 beats per minute during this phase is recommended, as well as in hospital monitoring for at least 48 hours. Patients with high-risk features for arrhythmias, such as congestive heart failure or impaired left ventricular function, may require pacing at higher rates. Adjustment of the pacing rate-although rarely below 70 beats per minute-is usually undertaken after a week in most patients, preferably after an electrocardiographic evaluation for repolarization abnormalities at the lower rate.
Authors:
Karolina Nowinski; Fredrik Gadler; Mats Jensen-Urstad; Lennart Bergfeldt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The American journal of medicine     Volume:  113     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-12-02     Completed Date:  2002-12-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  596-602     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Karolinska Institutet at Karolinska Hospital, S-171 76 Stockholm, Sweden
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MeSH Terms
Descriptor/Qualifier:
Atrioventricular Node / physiopathology*
Catheter Ablation / adverse effects*,  methods
Death, Sudden, Cardiac / etiology,  prevention & control
Humans
Practice Guidelines as Topic
Tachycardia, Ventricular / complications,  etiology*,  physiopathology*,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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