Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2012 Oct;35(1):63-9.
doi: 10.1007/s10840-012-9680-7. Epub 2012 May 5.

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump

Joelci Tonet  1 , Antonio De Sisti, Natalia Pardo Restrepo, Denis Raguin, Walid Amara, Manlio F Márquez, Philip Aouate, Xavier Waintraub, Faouzi Touil, Francoise Hidden-Lucet
Affiliations
Multicenter Study

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump

Joelci Tonet et al. J Interv Card Electrophysiol. 2012 Oct.

Abstract

Purpose: A residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump.

Methods: We analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter. Success was defined as AVNRT non-inducibility. Patients with no baseline elicitable jump, no inducible AVNRT, and transient first atrioventricular (AV) block at the last site were excluded.

Results: From 371 patients who underwent cryoablation from May 2002 to March 2011, 303 fulfilled the entry criteria (mean age, 41 ± 16; 222 women). Baseline AV nodal effective refractory period (ERP) was 272 ± 57 ms, postprocedural 331 ± 64 (P < 0.001), and the mean of the difference (Δ ERP) 60 ± 41. At the end of the procedure, 64 patients (21 %) had a residual jump, of whom 22 with a single echo. At 12 months follow-up, the actuarial recurrence-free rate was 70.3 % in patients with a residual jump and 86 % in those without (P = 0.01). In patients with a jump, only Δ AV nodal ERP was correlated with recurrence (37 ± 41 vs. 68 ± 47 ms; P < 0.04) while a single echo was not. The actuarial rate of recurrence was 60.8 % in patients with a Δ AV nodal ERP ≤ 30 ms and 18.8 % in those with a Δ AV nodal ERP >30 ms (P < 0.01).

Conclusions: Suppression of slow pathway conduction is the optimal endpoint for AVNRT cryoablation. A residual jump can be tolerated if AV nodal ERP postcryoablation is prolonged >30 ms.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
An example of optimal target site for AVNRT slow pathway cryoablation. Note an A/V ratio of about 1 and a stable nodal AV potential. AVNRT atrioventricular nodal reentry tachycardia, A/V atrioventricular
Fig. 2
Fig. 2
AVNRT recurrence-free event depending on postprocedural residual slow pathway. Δ AV nodal ERP: difference between baseline and post-procedural nodal effective refractory period
Fig. 3
Fig. 3
Patients without postprocedural residual slow pathway. AVNRT recurrence-free event depending on Δ AV nodal ERP. AVNRT atrioventricular nodal reentry tachycardia, Δ AV nodal ERP difference between baseline and postprocedural nodal effective refractory period
Fig. 4
Fig. 4
Patients with post-procedural residual slow pathway. AVNRT recurrence-free event depending on Δ AV nodal ERP. AVNRT atrioventricular nodal reentry tachycardia, Δ AV nodal ERP difference between baseline and post-procedural nodal effective refractory period
See this image and copyright information in PMC

References

    1. De Sisti A, Tonet J. Cryoablation of atrioventricular nodal reentrant tachycardia: a clinical review. Pacing and Clinical Electrophysiology. 2011;10:1–8. - PubMed
    1. Stern JD, Rolnitzky L, Goldberg JD, Chinitz LA, Holmes DS, Bernstein NE, et al. Meta-analysis to assess the appropriate endpoint for slow pathway ablation of atrioventricular nodal reentrant tachycardia. Pacing and Clinical Electrophysiology. 2011;34:269–277. doi: 10.1111/j.1540-8159.2010.02948.x. - DOI - PubMed
    1. Gupta D, Al-Lamee RK, Earley MJ, Kistler P, Harris SJ, Nathan AW, et al. Cryoablation compared with radiofrequency ablation for atrioventricular nodal re-entrant tachycardia: analysis of factors contributing to acute and follow-up outcome. Europace. 2006;8:1022–1026. doi: 10.1093/europace/eul124. - DOI - PubMed
    1. Chanani NK, Chiesa NA, Dubin AM, Avasarala K, Van Hare GF, Collins KK. Cryoablation for atrioventricular nodal reentrant tachycardia in young patients: predictors of recurrence. Pacing and Clinical Electrophysiology. 2008;31:1152–1159. doi: 10.1111/j.1540-8159.2008.01156.x. - DOI - PMC - PubMed
    1. Sandilands A, Boreham P, Pitts-Crick J, Cripps T. Impact of cryoablation catheter size on success rates in the treatment of atrioventricular nodal re-entry tachycardia in 160 patients with long-term follow-up. Europace. 2008;10:683–686. doi: 10.1093/europace/eun094. - DOI - PubMed

Publication types

LinkOut - more resources