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European Heart Journal 1997 18(6):985-993;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European society of Cardiology

Multiple mechanisms of successful slow-pathway catheter ablation of common atrioventricular nodal re-entrant tachycardia

M. Brignole, P. Delise*, C. Menozzi{dagger}, N. Paparella{ddagger}, L. Gianfranchi, S. Themistoclakis*, A. Bonso*, G. Lolli{dagger} and P. Alboni{dagger}

Section of Arrhythmology, Ospedali Riuniti Lavagna, Italy
*Division of Cardiology, Ospedale Umber to I Mestre, Italy
{dagger}Section of Arrhythmology, Ospedale S Maria Nuova Reggio Emilia, Italy
{ddagger}Division of Cardiology, Ospedale Civile Cento, Italy

revised 10 September 1996; accepted 13 September 1996.

Correspondence: Michele Brignole, Via A Grilli 164, 16041 Borzonasca (GE), Italy

Abstract

BACKGROUND: In patients with atrioventricular nodal reentrant tachycardia, modifications of the antegrade atrioventricular nodal function curve caused by catheter ablation of the so-called slow pathway are heterogeneous, but have not yet been systematically evaluated.

AIMS: To test the hypothesis that successful treatment is independent of specific electrophysiological modifications of atrioventricular nodal conducting properties

METHODS: Standard electrophysiological parameters and comparable antegrade atrioventricular nodal function curves were obtained, before and after successful ablation, in 104 patients (mean age 52±16 years; 69 women) affected by the common form of atrioventricular nodal re-entrant tachycardia.

RESULTS: Three different major patterns of antegrade atrioventricular nodal function curve were caused by ablation: downward shift of the curve with disappearance of atrioventricular nodal duality, suggesting the elimination of the slow pathway in 54 (52%) patients (type 1); absence of clear modifications of the curve (and of slow pathway ablation) in 33 (32%) patients (type 2); upward shift of the curve, suggesting a further slowing of conduction velocity through the slow pathway in 17 (16%) patients (type 3). Type-1 pattern was more frequent in patients ≥45 years, whereas type-2 pattern was more frequent in those >45 years.

CONCLUSIONS: Successful ablation of atrioventricular nodal re-entrant tachycardia is independent of specific modifications of antegrade atrioventricular conduction and probably depends on critical nodal and perinodal tissue damage at different sites on the re-entrant circuit. The effects of ablation are influenced by patient age.

Key Words: Atrioventricular nodal re-entrant tachycardia • catheter ablation • electrophysiological evaluation


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