title: Catheter ablation of the atrioventricular junction using radiofrequency energy and a bilateral cardiac approach.
abstract: Radiofrequency current catheter ablation was used successfully to create complete atrioventricular (AV) block in 60 of 61 patients (98%) with drug refractory supraventricular tachyarrhythmias. The remaining patient developed Mobitz I AV block and is clinically improved (clinical efficacy 100%). In 54 patients (89%), complete AV block was achieved using a right-sided approach. Patients aged > 60 years needed significantly fewer right-sided radiofrequency applications to produce complete AV block (5.3 +/- 5.3 vs 11.1 +/- 10.0; p = 0.009). In 6 of 7 patients with unsuccessful right-sided ablation, a left ventricular approach was used. In each case, 1 to 4 additional radiofrequency applications produced complete AV block. Patients with unsuccessful right-sided ablation were generally younger than those with successful ablation (50 +/- 16 vs 64 +/- 11; p = 0.007). It is concluded that catheter ablation using radiofrequency current is an extremely effective means of producing complete AV block. Older patients appear to be more susceptible to right-sided radiofrequency approaches. Left ventricular ablation easily produces complete AV block in patients refractory to right-sided attempts.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5064.
authors.forename: R G
authors.initials: RG
authors.lastname: Trohman
authors.forename: T W
authors.initials: TW
authors.lastname: Simmons
authors.forename: S L
authors.initials: SL
authors.lastname: Moore
authors.forename: M S
authors.initials: MS
authors.lastname: Firstenberg
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.forename: J D
authors.initials: JD
authors.lastname: Maloney
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D002036:Bundle of His / Q000503:physiopathology; D002305:Cardiac Tamponade / Q000209:etiology; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013617:Tachycardia, Supraventricular / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000209:etiology