Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia

M. A. Lee, F. Morady, A. Kadish, D. J. Schamp, M. C. Chin, M. M. Scheimamn, J. C. Griffin, M. D. Lesh, D. Pederson, J. Goldberger, H. Calkins, M. De Buitleir, W. H. Kou, S. Rosenheck, J. Sousa, J. J. Langberg

Research output: Contribution to journalArticlepeer-review

303 Scopus citations

Abstract

The utility of transcatheter application of radiofrequency energy to eliminate atrioventricular nodal reentrant tachycardia (AVNRT) was investigated. Thirty-nine patients (mean age, 53 ± 20 years; range, 14-86 years) with medically refractory AVNRT underwent perinodal ablation with radiofrequency energy. A custom-designed 6F catheter with a large (3-mm-long) distal electrode and interelectrode pacing of 2 mm was used in the majority of cases. The catheter used for ablation was initially positioned across the tricuspid anulus to obtain the largest His bundle electrogram, then withdrawn to obtain the largest atrial:ventricular electrogram ratio, with a small His bundle electrogram (≤ 100 μV). Each application of radiofrequency energy (350-550 kHz, 16.2 ± 5.2 W) was stopped after 60 seconds or if PR prolongation or an impedance rise was noted. The endpoints of the procedure were persistent modification of atrioventricular nodal conduction (either first-degree atrioventricular block or impairment of ventriculoatrial conduction) and noninducibility of AVNRT before and during isoproterenol administration. Radiofrequency energy was applied a mean of 6.8 ± 3.5 times per session. After a mean follow-up of 8 ± 3.0 months, 32 of the 39 patients (82%) have been free of AVNRT, and did not have high grade AV block. Three patients (8%) developed complete atrioventricular block and had pacemakers implanted. Two patients had unsuccessful initial procedures, and two patients had initially successful ablations but had recurrences of tachycardia 4-6 weeks later. Elimiantion of AVNRT appeared to be due to effects on the retrograde fast pathway in most patients. Radiofrequency ablation of the perinodal right atrium appears to be safe and effective for treatment of typical AVNRT.

Original languageEnglish (US)
Pages (from-to)827-835
Number of pages9
JournalCirculation
Volume83
Issue number3
DOIs
StatePublished - 1991
Externally publishedYes

Keywords

  • catheter ablation
  • supraventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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