RADIOFREQUENCY ABLATION OF ATRIOVENTRICULAR NODE REENTRANT TACHYCARDIA - EXPERIENCE IN 302 PATIENTS

Radiofrequency catheter ablation was performed in 302 consecutive pati ents with drug refractory atrioventricular (AV) node reentrant tachyca rdia. Fast pathway ablation was attempted in 167 patients and was succ essful in 161 patients (96.4%). At a mean follow-up of 24 +/- 12 month s, there were 21 tachycardia recurrences (12.5%). A second fast pathwa y ablation was attempted in 17 patients and was successful in all but I patient. permanent complete AV block occurred in 12 patients (7.2%). Among the latter, late AV block was noted in 5 patients. Final succes s without pacemaker implantation was accomplished in 151 patients (90. 4%). Slow pathway was attempted in 135 patients and was successful in 130 patients (96.3%). Three patients in whom slow pathway ablation fai led underwent successful fast pathway ablation during the same session . At a mean follow-up of 14 +/- 11 months, there were 16 tachycardia r ecurrences (11.8%). A second slow pathway ablation was attempted in 16 patients and was successful in all but I patient. permanent complete AV block occurred in 3 patients (2.2%). An additional patient develope d 2:1 AV block during exercise, 3 months after ablation. Final success without pacemaker implantation was achieved in 129 patients (95.5%).F ast and slow pathway ablation had similar success and recurrence rates , procedure and fluoroscopy times, and number of radiofrequency pulses . However, the incidence of permanent complete AV block was higher fol lowing fast pathway ablation (p = 0.049). Although equally effective, slow pathway ablation is safer than fast pathway ablation, therefore, should be the first choice approach for treatment of AV node reentrant tachycardia.