Abstract

Background

Radiofrequency (RF) ablation of slow pathway (SP) is usually performed in sinus rhythm while monitoring the occurrence of a slow junctional rhythm (JR). JR although sensitive, is not specific for elimination of SP conduction. Our objective was to prospectively evaluate feasibility and safety of SP elimination using fast atrial rate pacing (FAP) during RF delivery.

Methods

Consecutive patients admitted for atrioventricular nodal re-rentrant tachycardia (AVNRT) ablation were included. The rate of proximal coronary sinus (CS) pacing was set to a value constantly yielding antegrade SP conduction, while carefully monitoring the AH interval. RF delivery (at the lower part of Koch’s triangle) was considered successful if the AH shortened ≥ 14 ms or if transition from Wenckebach (WK) periods to a 1:1 conduction occurred.

Results

24 patients were included (54 ± 20 y). Typical AVNRT was induced in all (cycle length 349 ± 83 ms). RF delivery during CS pacing (335 ± 73 ms) led to AH shortening by 51 ± 25 ms in 13 patients. In 10 patients, a transition from 3:2 or 4:3 WK periods to 1:1 conduction occurred during the successful pulse. In one patient, atrial fibrillation was systematically induced during FAP, requiring conventional ablation. Non-inducibility, and SP conduction disappearance was obtained in all patients. No patient developed AV block. After a follow-up of 12 ± 3 months, no recurrences were observed.

Conclusion

SP ablation using FAP during RF delivery allows direct visualisation of its disappearance. In our cohort of patients, this technique was feasible without safety compromise.

中文翻译：

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在 AVNRT 射频消融期间使用快速心房起搏改善顺行传导来消除慢通路：一项概念验证研究

摘要

背景

慢通路 (SP) 的射频 (RF) 消融通常在窦性心律下进行，同时监测慢交界性心律 (JR) 的发生。JR 虽然敏感，但并不专门用于消除 SP 传导。我们的目标是前瞻性评估在 RF 传输期间使用快速心房率起搏 (FAP) 消除 SP 的可行性和安全性。

方法

包括因房室结折返性心动过速 (AVNRT) 消融而入院的连续患者。近端冠状窦 (CS) 起搏的速率设置为不断产生顺行 SP 传导的值，同时仔细监测 AH 间隔。如果 AH 缩短 ≥ 14 ms 或如果发生从 Wenckebach (WK) 周期到 1:1 传导的过渡，RF 传输（在科赫三角形的下部）被认为是成功的。

结果

包括 24 名患者（54 ± 20 岁）。典型的 AVNRT 全部被诱导（周期长度 349 ± 83 ms）。CS 起搏期间的射频传输 (335 ± 73 ms) 导致 13 名患者的 AH 缩短了 51 ± 25 ms。在 10 名患者中，在成功脉冲期间发生了从 3:2 或 4:3 WK 周期到 1:1 传导的转变。一名患者在 FAP 期间系统性诱发心房颤动，需要常规消融。所有患者均获得非诱导性和 SP 传导消失。没有患者出现房室传导阻滞。随访 12±3 个月后，未观察到复发。

结论

在 RF 传输期间使用 FAP 的 SP 消融允许直接可视化其消失。在我们的患者队列中，这项技术是可行的，不会危及安全性。