Transcoronary atrioventricular nodal modification using microvascular collagen.
Surgical and catheter based techniques for atrioventricular (AV) nodal modification have recently been described. Similarly, transcoronary embolization for the treatment of arrhythmias has recently emerged as a potentially useful approach. This report reviews our experience of a novel technique using embolization of the AV node with an inert agent, cross-linked collagen, for the treatment of AV nodal reentrant tachycardia. Three patients with refractory nodal tachycardia received 0.1-0.5 mL cross-linked collagen (2 mg/mL) delivered via a catheter placed within the nodal artery. All developed transient complete AV block with subsequent recovery of conduction. Two patients have had no further tachycardia and were noninducible at restudy. One patient required electrical modification because of recurrent symptoms. One patient sustained a limited posterior infarct due to back-spill of collagen into the distal right coronary artery. This novel technique provides an alternative approach to a cure for AV nodal tachycardia without producing long-term heart block.
Sneddon
J F
JF
Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Linker
N J
NJ
O'Nunain
S
S
Simpson
I A
IA
Camm
A J
AJ
Ward
D E
DE
D001283:Atrioventricular Node; D006328:Cardiac Catheterization; D003094:Collagen / Q000008:administration & dosage / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006327:Heart Block / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000628:therapy*; D013997:Time Factors
D003094:Collagen