Selective atrionodal input ablation for induction of proximal complete heart block with stable junctional escape rhythm in patients with uncontrolled atrial fibrillation

Bernhard Strohmer, Chun Hwang, C. Thomas Peter, Peng-Sheng Chen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: The study tests the hypothesis that ablating all inputs to the atrioventricular (AV) node can result in complete heart block with stable junctional escape rhythm. Methods and Results: We attempted atrionodal input ablation in 76 consecutive patients with uncontrolled atrial fibrillation. Fast and slow pathways were first ablated. If there was no AV block, additional energy applications were done between fast and slow pathway locations. The patients were followed for 42 ± 11 months. Group I (n = 57) comprised patients with complete heart block and junctional escape rhythm (53 ± 4 beats/min) at the end of the procedure. The escape rhythm remained stable throughout follow-up. Group II (n = 15) were patients who failed the stepwise atrionodal input ablation and required AV junctional ablation guided by His bundle potential to achieve complete heart block. Four patients showed a slow escape rhythm after ablation (33 ± 4 beats/min). Others had no escape rhythm. All 15 pts remained pacemaker dependant. The total death rate of groups I and II was 18/57 (31.6%) vs 10/15 (66.7%), respectively (p <0.02). These differences could not be explained by a difference of left ventricular ejection fraction (0.42 ± 0.07 vs 0.41 ± 0.04, respectively, p = NS). Conclusions: (1) In most patients, ablation of both fast and slow pathways did not result in complete heart block, indicating the presence of multiple atrionodal inputs. (2) Ablation of all atrionodal inputs may result in complete heart block with stable junctional escape rhythm. (3) As compared with AV junctional ablation, atrionodal input ablation was associated with a lower mortality rate on long-term follow up.

Original languageEnglish (US)
Pages (from-to)49-57
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume8
Issue number1
DOIs
StatePublished - Feb 2003
Externally publishedYes

Fingerprint

Heart Block
Atrial Fibrillation
Bundle of His
Atrioventricular Node
Mortality
Atrioventricular Block
Stroke Volume

Keywords

  • Atrial fibrillation
  • Atrioventricular node
  • Catheter ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Selective atrionodal input ablation for induction of proximal complete heart block with stable junctional escape rhythm in patients with uncontrolled atrial fibrillation",
abstract = "Background: The study tests the hypothesis that ablating all inputs to the atrioventricular (AV) node can result in complete heart block with stable junctional escape rhythm. Methods and Results: We attempted atrionodal input ablation in 76 consecutive patients with uncontrolled atrial fibrillation. Fast and slow pathways were first ablated. If there was no AV block, additional energy applications were done between fast and slow pathway locations. The patients were followed for 42 ± 11 months. Group I (n = 57) comprised patients with complete heart block and junctional escape rhythm (53 ± 4 beats/min) at the end of the procedure. The escape rhythm remained stable throughout follow-up. Group II (n = 15) were patients who failed the stepwise atrionodal input ablation and required AV junctional ablation guided by His bundle potential to achieve complete heart block. Four patients showed a slow escape rhythm after ablation (33 ± 4 beats/min). Others had no escape rhythm. All 15 pts remained pacemaker dependant. The total death rate of groups I and II was 18/57 (31.6{\%}) vs 10/15 (66.7{\%}), respectively (p <0.02). These differences could not be explained by a difference of left ventricular ejection fraction (0.42 ± 0.07 vs 0.41 ± 0.04, respectively, p = NS). Conclusions: (1) In most patients, ablation of both fast and slow pathways did not result in complete heart block, indicating the presence of multiple atrionodal inputs. (2) Ablation of all atrionodal inputs may result in complete heart block with stable junctional escape rhythm. (3) As compared with AV junctional ablation, atrionodal input ablation was associated with a lower mortality rate on long-term follow up.",
keywords = "Atrial fibrillation, Atrioventricular node, Catheter ablation",
author = "Bernhard Strohmer and Chun Hwang and Peter, {C. Thomas} and Peng-Sheng Chen",
year = "2003",
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doi = "10.1023/A:1022344032001",
language = "English (US)",
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pages = "49--57",
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TY - JOUR

T1 - Selective atrionodal input ablation for induction of proximal complete heart block with stable junctional escape rhythm in patients with uncontrolled atrial fibrillation

AU - Strohmer, Bernhard

AU - Hwang, Chun

AU - Peter, C. Thomas

AU - Chen, Peng-Sheng

PY - 2003/2

Y1 - 2003/2

N2 - Background: The study tests the hypothesis that ablating all inputs to the atrioventricular (AV) node can result in complete heart block with stable junctional escape rhythm. Methods and Results: We attempted atrionodal input ablation in 76 consecutive patients with uncontrolled atrial fibrillation. Fast and slow pathways were first ablated. If there was no AV block, additional energy applications were done between fast and slow pathway locations. The patients were followed for 42 ± 11 months. Group I (n = 57) comprised patients with complete heart block and junctional escape rhythm (53 ± 4 beats/min) at the end of the procedure. The escape rhythm remained stable throughout follow-up. Group II (n = 15) were patients who failed the stepwise atrionodal input ablation and required AV junctional ablation guided by His bundle potential to achieve complete heart block. Four patients showed a slow escape rhythm after ablation (33 ± 4 beats/min). Others had no escape rhythm. All 15 pts remained pacemaker dependant. The total death rate of groups I and II was 18/57 (31.6%) vs 10/15 (66.7%), respectively (p <0.02). These differences could not be explained by a difference of left ventricular ejection fraction (0.42 ± 0.07 vs 0.41 ± 0.04, respectively, p = NS). Conclusions: (1) In most patients, ablation of both fast and slow pathways did not result in complete heart block, indicating the presence of multiple atrionodal inputs. (2) Ablation of all atrionodal inputs may result in complete heart block with stable junctional escape rhythm. (3) As compared with AV junctional ablation, atrionodal input ablation was associated with a lower mortality rate on long-term follow up.

AB - Background: The study tests the hypothesis that ablating all inputs to the atrioventricular (AV) node can result in complete heart block with stable junctional escape rhythm. Methods and Results: We attempted atrionodal input ablation in 76 consecutive patients with uncontrolled atrial fibrillation. Fast and slow pathways were first ablated. If there was no AV block, additional energy applications were done between fast and slow pathway locations. The patients were followed for 42 ± 11 months. Group I (n = 57) comprised patients with complete heart block and junctional escape rhythm (53 ± 4 beats/min) at the end of the procedure. The escape rhythm remained stable throughout follow-up. Group II (n = 15) were patients who failed the stepwise atrionodal input ablation and required AV junctional ablation guided by His bundle potential to achieve complete heart block. Four patients showed a slow escape rhythm after ablation (33 ± 4 beats/min). Others had no escape rhythm. All 15 pts remained pacemaker dependant. The total death rate of groups I and II was 18/57 (31.6%) vs 10/15 (66.7%), respectively (p <0.02). These differences could not be explained by a difference of left ventricular ejection fraction (0.42 ± 0.07 vs 0.41 ± 0.04, respectively, p = NS). Conclusions: (1) In most patients, ablation of both fast and slow pathways did not result in complete heart block, indicating the presence of multiple atrionodal inputs. (2) Ablation of all atrionodal inputs may result in complete heart block with stable junctional escape rhythm. (3) As compared with AV junctional ablation, atrionodal input ablation was associated with a lower mortality rate on long-term follow up.

KW - Atrial fibrillation

KW - Atrioventricular node

KW - Catheter ablation

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