Efficacy of cryo-ablation during atrioventricular nodal reentrant tachycardia
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ORIGINAL ARTICLE
Efficacy of cryo‑ablation during atrioventricular nodal reentrant tachycardia Tadashi Hoshiyama1,2 · Keiichi Ashikaga1 · Kenichi Tsujita2 · Yoshisato Shibata1 Received: 29 June 2020 / Accepted: 16 October 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Because of the low atrioventricular (AV) block risk during cryo-ablation, it has become possible to treat AV nodal reentrant tachycardia (AVNRT) during arrhythmia. This study aimed to investigate the clinical outcomes of performing cryo-ablation for AVNRT during arrhythmia. Twenty-three patients with AVNRT treated by cryo-ablation during arrhythmia were enrolled. Cryo-ablation was performed gradually from the bottom to above the paraseptal tricuspid annulus until AVNRT was terminated. If the slow pathway was not eliminated despite cryo-ablation terminating the AVNRT, additional cryo-ablation was performed at a higher site until the slow pathway elimination was achieved. AVNRT was terminated by cryo-ablation in all 23 patients. However, the slow pathway was only eliminated in 6 patients. Among the remaining 17 patients, the slow pathway could not be ablated because transient AV block occurred during cryo-ablation at a higher site in 8 patients; however, cryo-ablation at a higher site successfully eliminated the slow pathway in the other 9 patients. In these 9 patients, the distance from the bottom of tricuspid annulus to the site of slow pathway elimination was significantly longer than that from bottom of tricuspid annulus to the AVNRT termination site (20.1 ± 5.3 vs 14.7 ± 4.5 mm: p = 0.027). During follow-up, AVNRT recurrence was confirmed in 3 patients. In 1 of these 3 patients, even a slow pathway elimination was achieved by cryoablation at the AVNRT termination site. The AVNRT termination site may not be the ideal site for performing cryo-ablation. Keywords Supraventricular tachycardia · Atrioventricular nodal reentrant tachycardia · Electrophysiology · Cryo-ablation · Ablation during atrioventricular nodal reentrant tachycardia
Introduction Radiofrequency catheter ablation is the first-line therapy for symptomatic patients with atrioventricular nodal reentrant tachycardia (AVNRT) [1], because catheter ablation abolishes AVNRT with low risk of complications [2]. Slow pathway, which is a critical target for abolishing AVNRT, is usually located in the inferior or posterior part of a triangle on the corridor between the tricuspid annulus and coronary sinus (CS) ostium inferiorly and between the tricuspid annulus and the tendon of Todaro more superiorly [3]. Therefore, two ablation strategies using radiofrequency * Tadashi Hoshiyama tadashi@kumamoto‑u.ac.jp 1
Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1‑1‑1 Honjo, Kumamoto 860‑8556, Japan
2
catheter ablation have been proposed to date—the anatomical and electrogram-guided approaches. In the anatomical approach, radiofrequency catheter abla
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