Perinodal slow potential as a local guide for transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia: Therapeutic efficacy and electrophysiological mechanisms of success

Jiunn Lee Lin, Fang Yue Lin, Huey Ming Lo, Chuen Den Tseng, Tin Fu Cheng, Jin Jer Chen, Yung Zu Tseng, Wen Pin Lien

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background-A specific local indicator in the Koch's triangle could be critical to the complication-free treatment of atrioventricular nodal reentrant tachycardia by transcatheter radiofrequency ablation. Recording of perinodal slow potential reflects a slow conduction area, and probably indicates the location of the slow pathway component of the circuit. Specific ablation of the slow pathway would carry the least risk ofatrioventricular block. Methods and results-Guided by the mapped perinodal slow potential, atrioventricular nodal reentrant tachycardia was successfully eliminated in all of 55 consecutive patients in one session. Fifty two patients (94·5%) had confirmed slow potential at the final success sites. Despite the good result, the underlying electrophysiological mechanisms of early success from slow-potential-guiding catheter ablation were heterogeneous: selective slow pathway eradication in 31 patients (56·4%, group A), selective slow pathway modification in 18 patients (32·7%, group B), inadvertent fast pathway damage in six patients (10·9%, group C). Group B patients had the preservation of dual atrioventricular nodal pathways, adequate atrio-Hisian delay, fast pathway facilitation, and a higher frequency of inducible, single non-conducted nodal echo (15/18, 83·3% v 6/31, 19·4% in group A, P ≫ 0·001). The upper communicating path of the circuit was implicated as another site of radiofrequency destruction. Three recurrences were documented in follow up study. However, reablation by the same approach caused complete atrioventricular block in one patient (1·7%, 1/58 procedures). None of the local characteristics of ablation sites was an independent predictor ofprocedure outcome. Conclusions-Perinodal slow potential is not a specific slow pathway indicator in transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia. Multiple strategic sites of the reentry circuit may be damaged through similar local signals.

Original languageEnglish
Pages (from-to)268-276
Number of pages9
JournalHeart
Volume74
Issue number3
DOIs
Publication statusPublished - Jan 1 1995
Externally publishedYes

Fingerprint

Atrioventricular Nodal Reentry Tachycardia
Therapeutics
Catheter Ablation
Atrioventricular Block
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Perinodal slow potential as a local guide for transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia : Therapeutic efficacy and electrophysiological mechanisms of success. / Lin, Jiunn Lee; Lin, Fang Yue; Lo, Huey Ming; Tseng, Chuen Den; Cheng, Tin Fu; Chen, Jin Jer; Tseng, Yung Zu; Lien, Wen Pin.

In: Heart, Vol. 74, No. 3, 01.01.1995, p. 268-276.

Research output: Contribution to journalArticle

Lin, Jiunn Lee ; Lin, Fang Yue ; Lo, Huey Ming ; Tseng, Chuen Den ; Cheng, Tin Fu ; Chen, Jin Jer ; Tseng, Yung Zu ; Lien, Wen Pin. / Perinodal slow potential as a local guide for transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia : Therapeutic efficacy and electrophysiological mechanisms of success. In: Heart. 1995 ; Vol. 74, No. 3. pp. 268-276.
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abstract = "Background-A specific local indicator in the Koch's triangle could be critical to the complication-free treatment of atrioventricular nodal reentrant tachycardia by transcatheter radiofrequency ablation. Recording of perinodal slow potential reflects a slow conduction area, and probably indicates the location of the slow pathway component of the circuit. Specific ablation of the slow pathway would carry the least risk ofatrioventricular block. Methods and results-Guided by the mapped perinodal slow potential, atrioventricular nodal reentrant tachycardia was successfully eliminated in all of 55 consecutive patients in one session. Fifty two patients (94·5{\%}) had confirmed slow potential at the final success sites. Despite the good result, the underlying electrophysiological mechanisms of early success from slow-potential-guiding catheter ablation were heterogeneous: selective slow pathway eradication in 31 patients (56·4{\%}, group A), selective slow pathway modification in 18 patients (32·7{\%}, group B), inadvertent fast pathway damage in six patients (10·9{\%}, group C). Group B patients had the preservation of dual atrioventricular nodal pathways, adequate atrio-Hisian delay, fast pathway facilitation, and a higher frequency of inducible, single non-conducted nodal echo (15/18, 83·3{\%} v 6/31, 19·4{\%} in group A, P ≫ 0·001). The upper communicating path of the circuit was implicated as another site of radiofrequency destruction. Three recurrences were documented in follow up study. However, reablation by the same approach caused complete atrioventricular block in one patient (1·7{\%}, 1/58 procedures). None of the local characteristics of ablation sites was an independent predictor ofprocedure outcome. Conclusions-Perinodal slow potential is not a specific slow pathway indicator in transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia. Multiple strategic sites of the reentry circuit may be damaged through similar local signals.",
author = "Lin, {Jiunn Lee} and Lin, {Fang Yue} and Lo, {Huey Ming} and Tseng, {Chuen Den} and Cheng, {Tin Fu} and Chen, {Jin Jer} and Tseng, {Yung Zu} and Lien, {Wen Pin}",
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T1 - Perinodal slow potential as a local guide for transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia

T2 - Therapeutic efficacy and electrophysiological mechanisms of success

AU - Lin, Jiunn Lee

AU - Lin, Fang Yue

AU - Lo, Huey Ming

AU - Tseng, Chuen Den

AU - Cheng, Tin Fu

AU - Chen, Jin Jer

AU - Tseng, Yung Zu

AU - Lien, Wen Pin

PY - 1995/1/1

Y1 - 1995/1/1

N2 - Background-A specific local indicator in the Koch's triangle could be critical to the complication-free treatment of atrioventricular nodal reentrant tachycardia by transcatheter radiofrequency ablation. Recording of perinodal slow potential reflects a slow conduction area, and probably indicates the location of the slow pathway component of the circuit. Specific ablation of the slow pathway would carry the least risk ofatrioventricular block. Methods and results-Guided by the mapped perinodal slow potential, atrioventricular nodal reentrant tachycardia was successfully eliminated in all of 55 consecutive patients in one session. Fifty two patients (94·5%) had confirmed slow potential at the final success sites. Despite the good result, the underlying electrophysiological mechanisms of early success from slow-potential-guiding catheter ablation were heterogeneous: selective slow pathway eradication in 31 patients (56·4%, group A), selective slow pathway modification in 18 patients (32·7%, group B), inadvertent fast pathway damage in six patients (10·9%, group C). Group B patients had the preservation of dual atrioventricular nodal pathways, adequate atrio-Hisian delay, fast pathway facilitation, and a higher frequency of inducible, single non-conducted nodal echo (15/18, 83·3% v 6/31, 19·4% in group A, P ≫ 0·001). The upper communicating path of the circuit was implicated as another site of radiofrequency destruction. Three recurrences were documented in follow up study. However, reablation by the same approach caused complete atrioventricular block in one patient (1·7%, 1/58 procedures). None of the local characteristics of ablation sites was an independent predictor ofprocedure outcome. Conclusions-Perinodal slow potential is not a specific slow pathway indicator in transcatheter radiofrequency ablation of atrioventricular nodal reentrant tachycardia. Multiple strategic sites of the reentry circuit may be damaged through similar local signals.

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