Mh. Hsieh et al., ABSENCE OF JUNCTIONAL RHYTHM DURING SUCCESSFUL SLOW-PATHWAY ABLATION IN PATIENTS WITH ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA, Circulation, 98(21), 1998, pp. 2296-2300
Citations number
26
Categorie Soggetti
Peripheal Vascular Diseas",Hematology,"Cardiac & Cardiovascular System
Background-The presence of junctional rhythm has been considered to be
a sensitive marker of successful slow-pathway ablation, However, in r
are cases, junctional rhythm was absent despite multiple radiofrequenc
y applications delivered over a large area in the Koch's triangle, and
successful ablation was achieved in the absence of a junctional rhyth
m. Methods and Results-This study included 353 patients with AV nodal
reentrant tachycardia (143 men and 210 women; mean age, 50+/-17 years)
who underwent catheter ablation of the slow pathway. Combined anatomi
c and electrogram approaches were used to guide ablation. Inducibility
of AV nodal reentrant tachycardia was assessed after each application
of radiofrequency energy. Successful sites were located in the poster
ior area in 18 (90%) of 20 patients without junctional rhythm during s
low-pathway ablation compared with 200 (60%) of 333 patients with junc
tional rhythm (P<0.001). The fast-slow form of tachycardia was more co
mmon in patients without than in those with junctional rhythm (30% ver
sus 3%; P=0.001). At the successful ablation sites, patients with junc
tional rhythm had a higher incidence of a multicomponent or slow-pathw
ay potential (51% versus 10%; P<0.001), a longer duration of the atria
l electrogram (64+/-8 versus 50+/-9 ms; P=0.04), and a smaller atrial/
ventricular electrogram amplitude ratio (0.29+/-0.18 versus 0.65+/-0.2
7; P<0.001) than those without junctional rhythm. Mean temperatures at
successful sites (56+/-6 degrees C versus 58+/-9 degrees C; P=0.57) a
nd incidence of transient AV block (2% versus 0%; P=0.86) were similar
between patients with and without junctional rhythms. By multivariate
analysis, location of ablation sites, atrial/ventricular electrogram
amplitude ratio, absence of a multicomponent or slow-pathway potential
, and occurrence of the fast-slow form of tachycardia were independent
predictors of the absence of a junctional rhythm during successful sl
ow-pathway ablation.