Transvenous Radiofrequency Ablation Theraphy as an Effective and Safe Method for The Treatment of The Slow Pathway Of Atrioventricular Nodal Re-Entrant Tachycardia

Öz

Background: The typical atrioventricular nodal re-entrant tachycardia (AVNRT) can be cured with the slow pathway ablation. In this study, we have analyzed a consecutive series of patients with typical AVNRT who underwent slow-pathway ablation which is a safe, effective and reproducible strategy using radiofrequency (RF) energy. Patients and Method: Fifty consecutive patients with symptomatic drug-resistant typical (slow-fast) AVNRT underwent an invasive electrophysiology study and RF ablation (RFA) of slow conduction pathway within atrioventricular (AV) node. The endpoints of ablation were induction of a retrogradely conducted junctional rhythm, and non-inducibility of AVNRT on atropine. Results: Fifty consecutive patients (age: 42.5 ± 15.4 years, body mass index: 25.56 ± 3.67 kg/m2, waist/hip ratio: 0.84 ± 7.164E-02, systolic blood pressure: 119.20 ± 13.57 mmHg, diastolic blood pressure: 74.40 ± 8.06 mmHg, rest heart rate: 76.20 ± 7.25 beat/min) with slow-fast AVNRT (40 women, 10 men) were ablated. AVNRT was induced during electrophysiological study. RFA successfully eliminated tachyarrhythmia in 50 (100%) patients. The AH interval was decreased in the post-ablation period as compared with pre-ablation period and no immediate conduction disturbances. Procedure and fluoroscopy times were 65.4 ± 19.0 and 13.4 ± 3.6 min respectively. No patient presented with AV block of any degree. Conclusions: The transvenous radiofrequency ablation therapy is a safe and effective approach for AVNRT, but care should be taken to use it in a way with full understanding of its possibilities and limitations, otherwise it could lead to disappointing results.

Anahtar Kelimeler

• Tachycardia, Atrioventricular Nodal Reentry, Ablation Techniques, AtriOventricular Block.

Atriyoventriküler Nodal Re-Entran Taşikardide Yavaş Yolun Etkili ve Güvenilir Bir Metod Olan Transvenöz Radyofrekans İle Ablasyonu

Öz

Giriş: Tipik atriyoventriküler nodal re-entran taşikardi (AVNRT) yavaş yol ablasyonu ile tedavi edilebilir. Biz bu çalışmada radyofrekans (RF) enerjisini kullanan ve güvenli, etkili ve yeniden üretilebilir bir strateji olan yavaş yol ablasyonunu geçirmiş tipik AVNRT'li ardışık hasta serisini analiz ettik.Hastalar ve Metod: Semptomatik ilaca dirençli tipik (yavaş-hızlı) AVNRT'li elli ardışık hastaya invaziv elektrofizyoloji çalışması ve atriyoventriküler (AV) içinde yavaş iletim yolunun RF ablasyonunu (RFA) yapıldı. Ablasyonun son noktaları retrograd iletimli kavşak ritminin uyarılması ve atropin üzerinden AVNRT'nin uyarılamaması idi. Bulgular: Yavaş-hızlı AVNRT'li (40 kadın, 10 erkek) elli ardışık hasta (yaş: 42.5 ± 15.4 yıl, vücut kitle indeksi: 25.56 ± 3.67 kg/m2, bel/kalça oranı: 0.84 ± 7.164E-02, sistolik kan basıncı: 119.20 ± 13.57 mmHg, diyastolik kan basıncı: 74.40 ± 8.06 mmHg, istirahat kalp hızı: 76.20 ± 7.25 atım/dakika) ablate edildi. AVNRT elektrofizyolojik çalışma sırasında uyarıldı. RFA taşiaritmiyi 50 (%100) hastada başarıyla dışladı. AH aralığı pre-ablasyon periyotla kıyaslayınca post-ablasyon periyotta azaldı ve hızlı iletim bozukluğu yoktu. Prosedür ve floroskopi zamanları sırasıyla 65.4 ± 19.0 ve 13.4 ± 3.6 dakikaydı. Hastalar herhangi bir derecede AV bloğu göstermedi. Sonuç: Transvenöz radyofrekans ablasyon tedavisi AVNRT için güvenli ve etkili bir yaklaşımdır, fakat kullanımı için olasılıklarını ve limitlerini tamamen anlayarak dikkatli olunmalıdır, aksi taktirde hayal kırıklığı ile sonuçlanabilir.

Anahtar Kelimeler

• Taşikardi, Atrioventriküler Düğüm Yeniden Girişi, Ablasyon Teknikleri, Atriyoventriküler Blok.

Kaynakça

1. Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofre- quency catheter ablation of slow-pathway conduction. N Engl J Med 1992;327:313-8.
2. Haissaguerre M, Gaita F, Fischer B, Commenges D, Mont- serrat P, D'Ivernois C, et al. Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation ;85:2162-75.
3. Giazitzoglou E, Korovesis S, Kokladi M, Venetsanakos I, Paxinos G, Katritsis DG. Slow-pathway ablation for atrioven- tricular nodal re-entrant tachycardia with no risk of atrioven- tricular block. Hellenic J Cardiol 2010;51:407-12.
4. Dindar A. Pediatric cardiac arrhythmias. Turkiye Klinikleri J Int Med Sci 2005;1:123-34.
5. Spector P, Reynolds MR, Calkins H, Sondhi M, Xu Y, Mar- tin A, et al. Meta-analysis of ablation of atrial flutter and su- praventricular tachycardia. Am J Cardiol 2009;104:671-7.
6. Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, et al. ACC/AHA guidelines for the clinical application of echocardiography: executive summa- ry. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Com- mittee on Clinical Application of Echocardiography). Devel- oped in collaboration with the American Society of Echocar- diography. J Am Coll Cardiol 1997;29:862-79.
7. Zipes DP, DiMarco JP, Gillette PC, Jackman WM, My- erburg RJ, Rahimtoola SH, et al. Guidelines for clinical in- tracardiac electrophysiological and catheter ablation pro- cedures. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guide- lines (Committee on Clinical Intracardiac Electrophysiologic and Catheter Ablation Procedures), developed in collabora- tion with the North American Society of Pacing and Electro- physiology. J Am Coll Cardiol 1995;26:555-73.
8. Katritsis DG, Camm AJ. Atrioventricular nodal reentrant tachycardia. Circulation 2010;122:831-40.

9. Ricard P, Latcu DG, Yaïci K, Zarqane N, Saoudi N. Slow pathway radiofrequency ablation in patients with AVNRT: junctional rhythm is less frequent during magnetic naviga- tion ablation than with the conventional technique. Pacing Clin Electrophysiol 2010;33:11-5.
10. Natale A, Greenfield RA, Geiger MJ, Newby KH, Kent V, Wharton JM, et al. Safety of slow pathway ablation in patients with long PR interval: further evidence of fast and slow path- way interaction. Pacing Clin Electrophysiol 1997;20:1698-703.
11. Reithmann C, Hoffmann E, Grünewald A, Nimmermann P, Remp T, Dorwarth U, et al. Fast pathway ablation in pa- tients with common atrioventricular nodal reentrant tachy- cardia and prolonged PR interval during sinus rhythm. Eur Heart J 1998;19:929-35.
12. Li YG, Grönefeld G, Bender B, Machura C, Hohnloser SH. Risk of development of delayed atrioventricular block af- ter slow pathway modification in patients with atrioventricu- lar nodal reentrant tachycardia and a pre-existing prolonged PR interval. Eur Heart J 2001;22:89-95.
13. Silver ES, Silva JN, Ceresnak SR, Chiesa NA, Rhee EK, Dubin AM, et al. Cryoablation with an 8-mm tip catheter for pediatric atrioventricular nodal reentrant tachycardia is safe and efficacious with a low incidence of recurrence. Pacing Clin Electrophysiol 2010;33:681-6.
14. Papez AL, Al-Ahdab M, Dick M 2nd, Fischbach PS. Tran- scatheter cryotherapy for the treatment of supraventricular tachyarrhythmias in children: a single center experience. J Interv Card Electrophysiol 2006;15:191-6.