Ablation of atrioventricular node
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- MeSH
- antiarytmika farmakokinetika terapeutické užití MeSH
- atrioventrikulární nodální reentry tachykardie diagnóza epidemiologie etiologie MeSH
- diferenciální diagnóza MeSH
- elektrofyziologické techniky kardiologické trendy využití MeSH
- katetrizační ablace metody trendy využití MeSH
- lidé MeSH
- nodus atrioventricularis chirurgie patofyziologie MeSH
- Check Tag
- lidé MeSH
AIMS: Interventional cardiology procedures may expose patients and staff to considerable radiation doses. We aimed to assess whether exposure to ionizing radiation during catheter ablation of supraventricular tachycardia (SVT) can be completely avoided. METHODS AND RESULTS: In this prospective randomized study, patients with SVT (atrioventricular re-entrant tachycardia n = 94, typical atrial flutter n = 29) were randomly assigned in a 1:1 ratio to catheter ablation with conventional fluoroscopic guidance (CF group) or with the EnSite Precision mapping system [zerofluoro (ZF) group]. Acute procedural parameters, increased stochastic risk of cancer incidence and 6-month follow-up data were assessed. Between May 2019 and August 2020, 123 patients were enrolled. Clinical parameters were comparable. Median procedural time was 60.0 and 58.0 min, median fluoroscopy time and estimated median effective dose were 240 s vs. 0 and 0.38 mSv vs. 0 and arrhythmia recurrence was 5% and 7.9% in the CF and ZF groups, respectively. The acute success rate was 98.4% in both groups. No procedure-related complications were reported. At an average age of 55.5 years and median radiation exposure of 0.38 mSv, the estimate of increased incidence was approximately 1 in 14 084. The estimated mortality rate was 1 per 17 857 exposed persons. CONCLUSIONS: The procedural safety and efficacy of the zero-fluoroscopic approach are similar to those of conventional fluoroscopy-based ablation for atrioventricular nodal re-entrant tachycardia and atrial flutter. Under the assumption of low radiation dose, the excessive lifetime risk of malignancy in the CF group due to electrophysiology procedure is reasonably small, whilst totally reduced in zero fluoroscopy procedures.
- MeSH
- atrioventrikulární nodální reentry tachykardie * diagnostické zobrazování chirurgie MeSH
- fluoroskopie metody MeSH
- flutter síní * diagnostické zobrazování chirurgie MeSH
- katetrizační ablace * škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- nodus atrioventricularis MeSH
- prospektivní studie MeSH
- srdeční arytmie chirurgie MeSH
- supraventrikulární tachykardie * diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- MeSH
- fibrilace komor etiologie terapie MeSH
- fibrilace síní chirurgie terapie MeSH
- katetrizační ablace škodlivé účinky MeSH
- lidé MeSH
- nodus atrioventricularis chirurgie MeSH
- senioři MeSH
- srdeční resynchronizační terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: Atrioventricular (AV) conduction turbulence, biphasic dromotropic response of AV node to single ventricular premature contraction (VPC), consists of early shortening and later prolongation of AV conduction intervals due to the direct electrophysiological mechanisms and perturbation in autonomic modulation. We investigated the acute effect of radiofrequency catheter ablation of slow pathway on AV turbulence. METHODS: The electrophysiological study was performed in 18 patients (7 men, mean age 49 ± 15 years) undergoing catheter ablation for AV nodal reentrant tachycardia. The stimulation protocol consisting of series of isolated VPC (coupling interval of 273 ± 23 ms) delivered from right ventricle apex during constant atrial pacing at 100 bpm was performed immediately prior to and 8 ± 4 min after successful slow-pathway ablation. Averaged post-VPCs profiles of AV conduction intervals were analyzed by purpose-written software. The descriptors of AV turbulence, turbulence onset (TOAV), turbulence slope (TSAV), and AV recovery (R AV) were assessed. RESULTS: Slow-pathway ablation suppressed the AV nodal responsiveness to VPC as evidenced by significant reduction of AV turbulence indices: TOAV: -6.4 ± 7.5 % vs. -4.3 ± 6.1 % (p < 0.05); TSAV: 2.0 ± 2.6 ms/RRi vs. 1.0 ± 0.7 ms/RRi (p < 0.05); and R AV: -13.8 ± 7.3 % vs. -6.5 ± 12.7 % (p < 0.05). CONCLUSIONS: Slow-pathway ablation significantly attenuated both vagal and non-autonomic modulation of AV nodal conduction. This effect is likely due to direct thermal injury of AV node associated with the change of properties of AV nodal fast-pathway although specific alteration of peri-AV nodal ganglionated plexi or their neural inputs into the AV node cannot be excluded.
- MeSH
- atrioventrikulární nodální reentry tachykardie patofyziologie chirurgie MeSH
- autonomní nervový systém patofyziologie MeSH
- elektrokardiografie MeSH
- katetrizační ablace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
AIMS: In patients with severe neurally mediated syncope (NMS), radiofrequency catheter ablation (RFA) of ganglionic plexi (GP) has been proposed as a new therapeutic approach. Cardio-inhibitory response during NMS is usually related to the sinoatrial (SA) and less frequently to atrioventricular (AV) node. Differential effect of GP ablation on SA and AV node is poorly understood. METHODS AND RESULTS: We report a case of a 35-year-old female with frequent symptomatic episodes of advanced AV block treated by anatomically guided RFA at empirical sites of GPs. After RFA at the septal portion of the right atrium-superior vena cava junction, heart rate accelerated from 62 to 91 beats/min and PR interval prolonged from 213 to 344 ms. Sustained first-degree AV block allowed to observe directly the effects of subsequent RFA on the AV nodal properties. Subsequent RFA at right- and left-sided aspects of the inter-atrial septum had no further effect on heart rate and PR interval. Ablation at the inferior left GP was critical for restoration of normal AV conduction (final PR interval of 187 ms). No bradycardia episodes were observed by implantable loop recorder during the follow-up of 10 months and the patient was symptomatically improved. CONCLUSION: This is the first clinical case showing the differential effect of GP ablation on SA and AV nodal function, and critical importance of targeting the GP at the postero-inferior left atrium. The successful procedure corroborates clinical utility of ablation treatment instead of pacemaker implantation in selected patients with cardio-inhibitory NMS.
- MeSH
- akční potenciály MeSH
- atrioventrikulární blokáda diagnóza patofyziologie chirurgie MeSH
- autonomní denervace metody MeSH
- časové faktory MeSH
- dospělí MeSH
- elektrofyziologické techniky kardiologické MeSH
- elektrokardiografie MeSH
- ganglia autonomní patofyziologie chirurgie MeSH
- katetrizační ablace * MeSH
- lidé MeSH
- nodus atrioventricularis patofyziologie MeSH
- nodus sinuatrialis patofyziologie MeSH
- recidiva MeSH
- srdeční frekvence MeSH
- stupeň závažnosti nemoci MeSH
- vazovagální synkopa diagnóza patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- akční potenciály MeSH
- atrioventrikulární nodální reentry tachykardie diagnóza patofyziologie chirurgie MeSH
- dospělí MeSH
- elektrofyziologické techniky kardiologické MeSH
- katetrizační ablace metody MeSH
- lidé MeSH
- nodus atrioventricularis inervace MeSH
- nodus sinuatrialis inervace MeSH
- srdeční frekvence MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Supraventricular tachycardia caused by AV nodal dual conduction is usually re-entry tachycardia. We report a case of a 40-year-old man with incessant supraventricular tachycardia caused by simultaneous conduction via slow and fast AV nodal pathway. The patient was successfully treated with catheter ablation of slow AV nodal pathway, the treatment of choice of this form of tachycardia (when proper diagnosis is made). Analysis of previously published cases is discussed.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- katetrizační ablace MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nodus atrioventricularis patologie MeSH
- ozbrojené síly MeSH
- senioři MeSH
- supraventrikulární tachykardie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Pulmonary vein isolation (PVI) by radiofrequency (RF) energy is associated with a collateral ganglionated plexi ablation. Pulsed electric field (PEF) is a nonthermal energy source that preferentially affects the myocardial cells and spares neural tissue. OBJECTIVES: This study investigated whether PVI by a PEF compared with RF energy will result in less prominent alteration of the cardiac autonomic nervous system. METHODS: A total of 31 patients with atrial fibrillation underwent PVI using a novel lattice-tip catheter and PEF energy (n = 18) or a conventional irrigated-tip catheter and RF energy (n = 13). The response of the sinoatrial node and atrioventricular node to extracardiac high-frequency, high-output, right vagal nerve stimulation was evaluated at baseline and during and at the end of the ablation procedure. Substantial reduction in responsiveness was arbitrarily defined as stimulation-inducible pause <1.5 seconds. RESULTS: Reduced response of the sinoatrial node was documented in 13 of 13 (100%) and 6 of 18 (33%) patients (P = 0.0001) in RF and PEF groups, respectively. Reduced response of the atrioventricular node was found in 10 of 11 (93%) and 6 of 18 (33%) patients (P = 0.002) in RF and PEF groups, respectively. The major effects were observed predominantly during ablation around the right pulmonary veins. Early recovery of ganglionated plexi function was noticed only in the PEF ablation group. RF ablation resulted in higher acceleration of the sinus rhythm compared with PEF ablation (20 ± 13 beats/min vs 12 ± 10 beats/min; P = 0.04). CONCLUSIONS: PEF compared with RF energy used for PVI induces significantly weaker and less durable suppression of cardiac autonomic regulations.
