Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia

A Contemporary, Multicenter Study

Demosthenes G. Katritsis, Theodoros Zografos, Konstantinos C. Siontis, George Giannopoulos, Rahul G. Muthalaly, Qiang Liu, Rakesh Latchamsetty, Zoltán Varga, Spyridon Deftereos, Charles Swerdlow, David J. Callans, John Miller, Fred Morady, Roy M. John, William G. Stevenson

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). Background: Published data are conflicting. Methods: The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. Results: Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). Conclusions: Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.

Original languageEnglish (US)
Pages (from-to)113-119
Number of pages7
JournalJACC: Clinical Electrophysiology
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2019

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Catheter Ablation
Tachycardia
Multicenter Studies
Confidence Intervals
Cardiac Arrhythmias
Recurrence
Atrioventricular Block
Isoproterenol
Odds Ratio
Survival

Keywords

  • ablation
  • atrioventricular
  • atypical
  • nodal
  • re-entrant
  • slow pathway
  • tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia : A Contemporary, Multicenter Study. / Katritsis, Demosthenes G.; Zografos, Theodoros; Siontis, Konstantinos C.; Giannopoulos, George; Muthalaly, Rahul G.; Liu, Qiang; Latchamsetty, Rakesh; Varga, Zoltán; Deftereos, Spyridon; Swerdlow, Charles; Callans, David J.; Miller, John; Morady, Fred; John, Roy M.; Stevenson, William G.

In: JACC: Clinical Electrophysiology, Vol. 5, No. 1, 01.01.2019, p. 113-119.

Research output: Contribution to journalArticle

Katritsis, DG, Zografos, T, Siontis, KC, Giannopoulos, G, Muthalaly, RG, Liu, Q, Latchamsetty, R, Varga, Z, Deftereos, S, Swerdlow, C, Callans, DJ, Miller, J, Morady, F, John, RM & Stevenson, WG 2019, 'Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia: A Contemporary, Multicenter Study', JACC: Clinical Electrophysiology, vol. 5, no. 1, pp. 113-119. https://doi.org/10.1016/j.jacep.2018.09.012
Katritsis, Demosthenes G. ; Zografos, Theodoros ; Siontis, Konstantinos C. ; Giannopoulos, George ; Muthalaly, Rahul G. ; Liu, Qiang ; Latchamsetty, Rakesh ; Varga, Zoltán ; Deftereos, Spyridon ; Swerdlow, Charles ; Callans, David J. ; Miller, John ; Morady, Fred ; John, Roy M. ; Stevenson, William G. / Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia : A Contemporary, Multicenter Study. In: JACC: Clinical Electrophysiology. 2019 ; Vol. 5, No. 1. pp. 113-119.
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abstract = "Objectives: This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). Background: Published data are conflicting. Methods: The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. Results: Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09{\%}) and 1 of permanent (0.09{\%}) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10{\%}) patients in the typical and 3 (3.90{\%}) patients in the atypical group (odds ratio: 0.525; 95{\%} confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70{\%} in typical and 96.10{\%} in atypical groups) had sensitivity of 95.9{\%} (95{\%} CI: 94.6{\%} to 97.0{\%}) and specificity of 4.20{\%} (95{\%} CI: 0.11{\%} to 21.10{\%}), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2{\%} (95{\%} CI: 62.2{\%} to 68.1{\%}) and specificity of 33.30{\%} (95{\%} CI: 15.60{\%} to 55.30{\%}). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). Conclusions: Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.",
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T2 - A Contemporary, Multicenter Study

AU - Katritsis, Demosthenes G.

AU - Zografos, Theodoros

AU - Siontis, Konstantinos C.

AU - Giannopoulos, George

AU - Muthalaly, Rahul G.

AU - Liu, Qiang

AU - Latchamsetty, Rakesh

AU - Varga, Zoltán

AU - Deftereos, Spyridon

AU - Swerdlow, Charles

AU - Callans, David J.

AU - Miller, John

AU - Morady, Fred

AU - John, Roy M.

AU - Stevenson, William G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). Background: Published data are conflicting. Methods: The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. Results: Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). Conclusions: Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.

AB - Objectives: This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). Background: Published data are conflicting. Methods: The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. Results: Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). Conclusions: Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success.

KW - ablation

KW - atrioventricular

KW - atypical

KW - nodal

KW - re-entrant

KW - slow pathway

KW - tachycardia

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