CROSS OVER: A RELIABLE MANEUVER IN THE CONFIRMATION OF ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA ABLATION

Authors

Abstract

 Background: Atrioventricular nodal re-entrant tachycardia (AVNRT) is still the most common presentation to our electrophysiology laboratory for ablation. The aim of this study is to document the confirmative value of cross over manoeuvre in successful AVNRT ablation. Methods: This study was conducted in Hayat Abad Medical complex Peshawar June 2006 to October 2015. In all patient with AVNRT, Dual-nodal pathway physiology confirmed by programmed atrial pacing of eight Tran with an extra beat by 10 millisecond (ms) decrement and at least Atrial HIS (A-H) interval prolongation of 50 ms. The dual pathway was further confirmed by cross over manoeuvre. Slow pathway potential identified and radiofrequency ablation (RFA) energy applied at 60 temperatures and 30 powers in Left Anterior Oblique (LAO) projection. Post ablation absence of cross over documented with and without isoproterenol and patient followed for any complication or recurrence. Results: Total 567 patients studied with mean age 36.56±12.16 and male to female ratio 1:1.4 with presentation of supra-ventricular tachycardia (SVT). Slow pathway was successfully modified and statistically no significant complication or recurrence documented. Conclusion: Failure to cross over reliably excludes any conduction over the slow pathway and so recurrence of AVNRT.Keywords: Atrioventricular nodal re-entrant tachycardia; AVNRT; Supra-ventricular tachycardia; SVT; Radiofrequency ablation; Dual nodal pathway; Physiology

References

Josephson ME, Wellens HJ. Differential diagnosis of supraventricular tachycardia. Cardiol Clin 1990;8(3):411–42.

Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949–953.

Bradbum C, Westfall R, McPheeters R. Reentrant supraventricular tachycardia in a pediatric trauma patient masquerading as a cardiac contusion. Cal J Emerg Med 2005;6(4):79–83.

Ho RT, Mark GE, Rhim ES, Pavri BB, Greenspon AJ. Differentiating atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia by DeltaHA values during entrainment from the ventricle. Heart Rhythm 2008;5(1):83–8.

Mani BC, Pavri BB. Dual Atrioventricular Nodal Pathways Physiology: A Review of Relevant Anatomy, Electrophysiology, and Electrocardiographic Manifestations. Indian Pacing Electrophysiol J 2014;14(1):12–25.

Velázquez Rodríguez E, Favela Pérez E. Ablation or modification of slow pathway in AV nodal reentrant tachycardia and electrophysiological changes. Arch Cardiol Mex 2006;76(2):169–78.

Jentzer JH, Goyal R, Williamson BD, Man KC, Neibauer M, Daoud E, et al. Analysis of junctional ectopy during radiofrequency ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia. Circulation 1994;90(6):2820–6.

Shailesh F, Sewani A, Paydak H. Recurrent A V block following ablation for AVNRT. Indian Heart J 2014;66(6):710–3.

Ferguson JD, DiMarco JP. Contemporary Management of Paroxysmal Supraventricular Tachycardia. Circulation 2003;107(8):1096–9.

Hamer AW, Tanasescu DE, Marks JW, Peter T, Waxman AD, Mandel WJ. Failure of episodic high-dose oral verapamil therapy to convert supraventricular tachycardia: a study of plasma verapamil levels and gastric motility. Am Heart J 1987;114(2):334–42.

Alboni P, Tomasi C, Menozzi C, Bottoni N, Pagarella N, Fuca G, et al. Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia. J Am Coll Cardiol 2001;37(2):548–53.

Ogburn PL Jr, Schmidt G, Linman J, Cefalo RC. Paroxysmal tachycardia and cardioversion during pregnancy. J Reprod Med 1982;27(6):359–62.

Pitschner HF, Neuzner J. Catheter ablation in supraventricular tachycardia. Z Kardiol 1996;85(Suppl 6):45–60.

Kanjwal K, George A, Mainigi S. Establishing the Mechanism of Supraventricular Tachycardia in the Electrophysiology Laboratory. J Innov Card Rhythm Manag 2013;4:1217–30.

Eckhardt LL, Leal M, Hollis Z, Tanega J, Alberte C. Cryoablation for AVNRT: importance of ablation endpoint criteria. J Cardiovasc Electrophysiol 2012;23(7):729–34.

Estner HL, Ndrepepa G, Dong J, Deisenhofer I, Schreieck J, Schneider M, et al. Acute and long-term results of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia--an analysis of the predictive factors for arrhythmia recurrence. Pacing Clin Electrophysiol 2005;28(2):102–10.

Feldman A, Voskoboinik A, Kumar S, Spence S, Morton JB, Kistler PM, et al. Predictors of acute and long-term success of slow pathway ablation for atrioventricular nodal reentrant tachycardia: a single center series of 1,419 consecutive patients. Pacing Clin Electrophysiol 2011;34(8):927–33.

Baker JH 2nd, Plumb VJ, Epstein AE, Kay GN. Predictors of recurrent atrioventricular nodal reentry after selective slow pathway ablation. Am J Cardiol 1994;73(11):765–9.

Moreira JM, Curimbaba J, Pimenta J. Slow junctional rhythm during catheter ablation of right posteroseptal accessory pathway causing transient atrioventricular block. Pacing Clin Electrophysiol 2003;26(3):770–2.

Stellbrink C, Diem B, Schauerte P, Brehmer K, Schuett H, Hanrath P. Differential effects of atropine and isoproterenol on inducibility of atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2001;5(4):463–9.

Schaffer MS, Silka MJ, Ross BA, Kugler JD. Inadvertent Atrioventricular Block During Radiofrequency Catheter Ablation. Result of the pediatric radiofrequency ablation registry. Pediatric electrophysiology society. Circulation 1996;94(12):3214–20.

Wellens HJ. Catheter Ablation of Cardiac Arrhythmias Usually Cure, but Complications May Occur. Circulation 1999;99(2):195–7.

Published

2017-06-25

Issue

Vol. 29 No. 3 (2017): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

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ORIGINAL ARTICLE

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