Ablative therapy for atrioventricular nodal reentry arrhythmias

Radiofrequency Catheter Ablation of Fast Pathway via Unconventional Right Subclavian Venous Access for Atrioventricular Nodal Reentrant Tachycardia

We report the case of a patient with atrioventricular nodal reentry tachycardia (AVNRT), who was found to have obstruction of the inferior vena cava (IVC) by a calcified mass during an electrophysiologic study (EPS). Subsequently, complete EPS was performed via a combined right internal jugular and subclavian venous access. Successful radiofrequency catheter ablation of the fast pathway was performed via the unconventional right subclavian venous route.

Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents

We report our experience in radiofrequency catheter ablation between April, 1992 and December, 1998, in which we treated 287 patients less than 18 years of age (mean 14.3 +/- 3.1 years) with supraventricular tachycardia. Accessory, pathways were the arrhythmic substrate in 252 of the patients (87.8%), the patients having a total of 265 accessory pathways. Atrioventricular nodal re-entry was the cause of tachycardia in 26 patients (9.0%), while atrial flutter was detected in the remaining 9 patients (3.1%). We were able successfully to eliminate the accessory pathway in 236 patients (89%), but 25 patients had recurrent arrhythmias. Ablation proved successful in all cases of atrioventricular node re-entry tachycardia, the slow pathway being ablated in 25 patients, and the fast pathway in only one case. Recurrence of the arrhythmia occurred in three patients (11.5%). We performed a second ablation in these children, all then proving successful. The ablation was successful in all cases of atrial flutter, with one recurrence (11.1%). Overall, therefore, ablation was immediately successful in 271 patients (94.4%), with a recurrence of the arrhythmia in 29 cases (10.7%). The incidence of serious complications was 2.09%. There was one late death due to infective endocarditis, 3 patients suffered complete heart block, 1 had mild mitral regurgitation, and 1 patient developed an haematoma in the groin. We conclude that radiofrequency catheter ablation can now be considered a standard option for the management of paroxysmal supraventricular tachycardias in children and young adults.

Palpitations: reassurance or more?

Palpitations are a common symptom and are caused by forceful or rapid beating of the heart. Palpitations can be caused by a variety of cardiac arrhythmias and careful history is invaluable in deciding appropriate investigations and management. Palpitations caused by anxiety-induced sinus tachycardia are common, but anxiety is also common in patients who have cardiac arrhythmias for which effective treatment is available. Management of palpitations depends on the type of cardiac arrhythmia; almost all arrhythmias can now be effectively treated. Radiofrequency ablation provides an effective cure for most patients with paroxysmal supraventricular tachycardia when the alternative is continuous drug therapy.

Catheter ablation for atrioventricular nodal reentrant tachycardia

The current status of catheter ablation techniques for the management of atrioventricular nodal reentry tachycardia is outlined in this article. Some pertinent aspects of the atrioventricular nodal anatomy and physiology are discussed, to the extent that they are essential for understanding of the mechanism of this arrhythmia and the technique of catheter ablation.

Analysis of electrophysiological activity in Koch's triangle relevant to ablation of the slow AV nodal pathway

Atrioventricular junctional reentrant tachycardia (AVJRT) is the most common form of paroxysmal regular supraventricular tachycardia. In patients with disabling, drug refractory AVJRT, catheter ablation has evolved rapidly from a last-resort treatment in the form of interruption of atrioventricular (AV) conduction to selective modification of AV nodal function as an ideal treatment. This article will focus on the frequently unappreciated electrophysiological activities recordable in man in Koch's triangle during ablation of the so-called slow pathway.