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. 2018 Mar 27;23(1):16.
doi: 10.1186/s40001-018-0314-0.

Clinical impact of "pure" empirical catheter ablation of slow-pathway in patients with non-ECG documented clinical on-off tachycardia

Shqipe Gerguri  1   2 , Nikesh Jathanna  1   2 , Tina Lin  3 , Patrick Müller  1   2 , Lukas Clasen  1   2 , Jan Schmidt  1   2 , Muhammed Kurt  1   2 , Dong-In Shin  1 , Christian Blockhaus  1 , Malte Kelm  1   2 , Alexander Fürnkranz  1   2 , Hisaki Makimoto  4   5
Affiliations

Clinical impact of "pure" empirical catheter ablation of slow-pathway in patients with non-ECG documented clinical on-off tachycardia

Shqipe Gerguri et al. Eur J Med Res. .

Abstract

Background: Catheter ablation of slow-pathway (CaSP) has been reported to be effective in patients with dual atrioventricular nodal conduction properties (dcp-AVN) and clinical ECG documentation but without the induction of tachycardia during electrophysiological studies (EPS). However, it is unknown whether CaSP is beneficial in the absence of pre-procedural ECG documentation and without the induction of tachycardia during EPS. The aim of this study was to evaluate long-term results after a "pure" empirical CaSP (peCaSP).

Methods: 334 consecutive patients who underwent CaSP (91 male, 47.5 ± 17.6 years) were included in this study. Sixty-three patients (19%) who had no pre-procedural ECG documentation, and demonstrated dcp-AVN with a maximum of one echo-beat were assigned to the peCaSP group. The remaining 271 patients (81%) were assigned to the standard CaSP group (stCaSP). Clinical outcomes of the two groups were compared, based on ECG documented recurrence or absence of tachycardia and patients' recorded symptoms.

Results: CaSP was performed in all patients without any major complications including atrioventricular block. During follow-up (909 ± 435 days), 258 patients (77%) reported complete cessation of clinical symptoms. There was no statistically significant difference in the incidence of AVNRT recurrence between the peCaSP and stCaSP groups (1/63 [1.6%] vs 3/271 [1.1%], P = 0.75). Complete cessation of clinical symptoms was noted significantly less frequently in patients after peCaSP (39/63 [62%] vs 219/271 [81%], P = 0.0013). The incidence of non-AVNRT atrial tachyarrhythmias (AT) was significantly higher in patients after peCaSP (5/63 [7.9%] vs 1/271 [0.4%], P = 0.0011).

Conclusion: A higher incidence of other AT and subjective symptom persistence are demonstrated after peCaSP, while peCaSP improves clinical symptoms in 60% of patients with non-documented on-off tachycardia.

Keywords: AVNRT; ECG documentation; Empiric ablation; Slow-pathway ablation; Supraventricular tachycardia.

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Figures

Fig. 1
Fig. 1
Schematic diagram of patient population and endpoints of catheter ablation. Out of 342 consecutive patients who underwent catheter ablation of slow-pathway (CaSP), 334 patients were routinely followed up after SPA. Pure empirical CaSP (see text) was performed in 63 patients without pre-procedural ECG documentation. AVNRT was induced in 164 patients and 2 or more echo-beats were noted in 60 patients
Fig. 2
Fig. 2
Pure Empirical Slow-Pathway Ablation and Follow-up Results. a Patients who underwent pure empirical catheter ablation of slow-pathway (CaSP) showed significantly higher incidence of other atrial tachycardia documentation during follow-up. b Patients who underwent pure empirical CaSP showed significantly lower complete symptom elimination during follow-up as compared to patients with standard CaSP. c Between patients with pure empirical CaSP and standard CaSP there was no significant difference in the recurrence of AVNRT. d There was significantly higher incidence of no symptomatic improvement in patients after pure empirical CaSP as compared to those after standard CaSP. P values were calculated with Fisher exact test (a, c, d) and with Chi-square test (b)
See this image and copyright information in PMC

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