Catheter Ablation of Accessory Pathways, Atrioventricular Nodal Reentrant Tachycardia, and the Atrioventricular Junction

TLDR

Catheter ablation of atrioventricular nodal reentrant tachycardia, accessory pathways, and the atrioventricular junction is a widely used therapeutic approach. The study aimed to evaluate the safety and efficacy of a temperature‑controlled radiofrequency catheter ablation system. The authors performed ablation on 1,050 patients with AVNRT, AP, or AVJ using this temperature‑controlled radiofrequency system. Ablation was successful in 996 patients (94.5 %), with the highest success for AVJ, lowest for AP, major complications occurred in 32 patients, and predictors of success, recurrence, complications, and death were identified.

Abstract

Background —The purpose of this study was to evaluate the safety and efficacy of a temperature-controlled radiofrequency catheter ablation system. Methods and Results —The patient population included 1050 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway (AP), or the atrioventricular junction (AVJ). Ablation was successful in 996 patients. The probability of success was highest among patients who had undergone ablation of the AVJ, lowest in patients who had undergone ablation of an AP, and in between for patients who had undergone ablation of AVNRT. A major complication occurred in 32 patients. Four variables predicted ablation success (AVJ, AVNRT, or left free wall AP ablation and an experienced center). Four factors predicted arrhythmia recurrence (right free wall, posteroseptal, septal, and multiple APs). Two variables predicted development of a complication (structural heart disease and the presence of multiple targets), and 3 variables predicted an increased risk of death (heart disease, lower ejection fraction, and AVJ ablation). Conclusions —These findings may serve as a guide to clinicians considering therapeutic options in patients who are candidates for ablation.