Skip Navigation

European Heart Journal 2001 22(1):89-95; doi:10.1053/euhj.2000.2182
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (9)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Li, Y.-G.
Right arrow Articles by Hohnloser, S.H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Li, Y.-G.
Right arrow Articles by Hohnloser, S.H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Risk of development of delayed atrioventricular block after slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a pre-existing prolonged PR interval

Y.-G. Li, G. Grönefeld, B. Bender, C. Machura and S.H. Hohnloserf1

Department of Internal Medicine, Divison of Cardiology, J. W. Goethe University, Frankfurt, Germany

Abstract

Aims The objective of this prospective study was to assess risk factors for the development of atrioventricular block following slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a pre-existing prolonged PR interval.

Methods and Results Of 346 consecutive patients with atrioventricular nodal reentrant tachycardia undergoing slow pathway modification, 18 patients (62±7 years; five females) were found to have a prolonged PR interval prior to ablation. Total elimination of the functional slow pathway was assumed if the antegrade effective refractory period following slow pathway modification was longer than the cycle length of atrioventricular nodal reentrant tachycardia. To detect atrioventricular node conduction disturbances, 24-h Holter recordings were performed 1 day prior to slow pathway modification, and 1 day, 1 week, 1, 3 and 6 months after the procedure. Six patients developed late atrioventricular block. The incidence of delayed atrioventricular block following successful slow pathway modification was higher in patients with, compared to patients without, prolonged PR interval at baseline (6/18 vs 0/328,P <0·001). In the former group, the antegrade effective refractory period was longer in patients with, compared to those without, a delayed atrioventricular block (492±150ms vs 332±101ms,P <0·05). The incidence of delayed atrioventricular block was higher in patients with total elimination of the slow pathway compared to patients without (5/7 vs 1/11,P <0·01).

Conclusions Slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a prolonged PR interval is highly effective. However, there is a significant risk of development of delayed atrioventricular block, particularly when the procedure results in total elimination of the slow pathway.

Key Words: Atrioventricular nodal reentrant tachycardia, radiofrequency catheter ablation, PR interval, atrioventricular block, complications

f1 Correspondence: Stefan H. Hohnloser, MD, FESC, FACC, J. W. Goethe University, Department of Medicine, Division of Cardiology, Theodor Stern Kai 7, 60590 Frankfurt, Germany.

References

  1. Jackman WM, Beckman KJ, McClelland JH. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992;327:313–318[Abstract]
  2. Haissaguevre M, Gaita F, Fischer B. Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation. 1992;85:2162–2175[Abstract/Free Full Text]
  3. Jazayeri MR, Hempe SL, Sra JS. Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation. 1992;85:1318–1328[Abstract/Free Full Text]
  4. Calkins H, Yong P, Miller JM. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction. Final results of a prospective, multicenter clinical trial. Circulation. 1999;99:262–270[Abstract/Free Full Text]
  5. Kay GN, Epstein AE, Dailey SM, Plumb VJ. Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia: evidence for involvement of perinodal myocardium within the reentrant circuit. Circulation. 1992;85:1675–1688[Abstract/Free Full Text]
  6. Wathen M, Natale A, Wolfe K, Yee R, Newman D, Klein G. An anatomically guided approach to atrioventricular node slow pathway ablation. Am J Cardiol. 1992;70:886–889[CrossRef][Web of Science][Medline]
  7. Li Y-G, Bogun F, Grönefeld G, Hohnloser SH. Randomized comparison of slow pathway modification within the posteroseptal versus the midseptal area in patients with atrioventricular nodal reentrant tachycardia. Am J Cardiol. 1998;82:1287–1290[CrossRef][Web of Science][Medline]
  8. Kalbfleisch SJ, Strickberger SA, Williamson B. Randomized comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of atrioventricular node reentrant tachycardia. J Am Coll Cardiol. 1994;23:716–723[Abstract]
  9. Chen SA, Chiang CE, Tsang WP. Selective radiofrequency catheter ablation of fast and slow pathways in 100 patients with atrioventricular nodal reentrant tachycardia. Am Heart J. 1993;125:1–10[CrossRef][Web of Science][Medline]
  10. Willems S, Shenasa H, Kottkamp H. Temperature-controlled slow pathway ablation for treatment of atrioventricular nodal reentrant tachycardia using a combined anatomical and electrogram guided strategy. Eur Heart J. 1996;17:1092–1102[Abstract/Free Full Text]
  11. Sra JS, Jazayeri MR, Blanck Z, Deshpande S, Dhala AA, Akhtar M. Slow pathway ablation in patients with atrioventricular node reentrant tachycardia and a prolonged PR interval. J Am Coll Cardiol. 1994;24:1064–1068[Abstract]
  12. Rigden LB, Klein LS, Mitrani RD, Zipes DP, Miles WM. Increased risk of heart block following slow pathway ablation for atrioventricular nodal reentrant tachycardia in patients with marked PR interval prolongation during sinus rhythm (Abstr). PACE. 1995;18:II–918
  13. Natale A, Greenfield RA, Geiger MJ. Safety of slow pathway ablation in patients with long PR interval: further evidence of fast and slow pathway interaction. PACE. 1997;20:1698–1703
  14. Josephson ME. Clinical Cardiac Electrophysiology. Techniques and Interpretations. 2nd edn. Philadelphia: Lea and Febiger; 1993. p. 224
  15. J Am Coll Cardiol. 1995;26:555–573[CrossRef][Web of Science][Medline]
  16. Kottkamp H, Hindricks G, Borggrefe M, Breithardt G. Radiofrequency catheter ablation of the anterosuperior and posteroinferior atrial approaches to the AV node for treatment of atrioventricular nodal reentrant tachycardia: Techniques for selective ablation of ‘fast’ and ‘slow’ atrioventricular node pathways. J Cardiovasc Electrophysiol. 1997;8:451–468[Web of Science][Medline]
  17. Basta MN, Krahn AD, Klein GJ, Rosenbaum M, Feuvre CL, Yee R. Safety of slow pathway ablation in patients with atrioventricular node reentrant tachycardia and a long fast pathway effective refractory period. Am J Cardiol. 1997;80:155–159[CrossRef][Web of Science][Medline]
  18. Boulos M, Hoch D, Schecter S, Greengerg S, Levine J. Age dependence of complete heart block complicating radiofrequency ablation of the atrioventricular nodal slow pathway. Am J Cardiol. 1998;82:390–391[CrossRef][Web of Science][Medline]
  19. Reithmann C, Hoffmann E, Grünewald A. Fast pathway ablation in patients with common atrioventricular nodal reentrant tachycardia and prolonged PR interval during sinus rhythm. Eur Heart J. 1998;19:929–935[Abstract/Free Full Text]
  20. Varotto L, Storti C, Salerno-Uriarte JA. Fast pathway ablation in a patient with iterative atrioventricular nodal reentrant tachycardia and prolonged PR interval. Internat J Cardiol. 1996;56:263–267[CrossRef]
  21. Verdino RJ, Burke MC, Kall JG. Retrograde fast pathway ablation for atrioventricular nodal reentry associated with markedly prolonged PR intervals. Am J Cardiol. 1999;83:455–458[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
J. Kihel, A. D. Costa, A. Kihel, C. Romeyer-Bouchard, J. Thevenin, R. Gonthier, B. Samuel, and K. Isaaz
Long-term efficacy and safety of radiofrequency ablation in elderly patients with atrioventricular nodal re-entrant tachycardia
Europace, June 1, 2006; 8(6): 416 - 420.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
J. L. Pasquie, J. Scalzi, J. C. Macia, F. Leclercq, and R. Grolleau-Raoux
Long-term safety and efficacy of slow pathway ablation in patients with atrioventricular nodal re-entrant tachycardia and pre-existing prolonged PR interval.
Europace, February 1, 2006; 8(2): 129 - 133.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (9)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Li, Y.-G.
Right arrow Articles by Hohnloser, S.H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Li, Y.-G.
Right arrow Articles by Hohnloser, S.H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?