Fulguration for AV nodal tachycardia: results in 42 patients with a mean follow-up of 23 months.
This report describes a catheter ablation technique to treat atrioventricular nodal reentrant tachycardia while preserving anterograde conduction, and its application in 42 patients with drug-refractory repetitive episodes of tachycardia. One of these patients had common and reverse forms of tachycardia. Using atrial activation in the His-bundle lead as a reference, the optimal ablation site was selected by positioning an electrode catheter to obtain a synchronous or earlier atrial activation than the reference during tachycardia. At this site, His-bundle deflection was completely absent, or was present at a low amplitude (less than 0.1 mV). In the majority of patients, these criteria were found in the immediate vicinity of the site of proximal His-bundle recording (adjacent to the reference catheter). Shocks of 160 or 240 joules (J) were delivered at this site (mean +/- SD = 518 +/- 392 J/session) with a resulting preferential abolition of impairment of fast retrograde conduction. Anterograde conduction, though modified, was preserved in all patients, except for four (10%) patients who remained in complete heart block. Thirty patients (70%) remained free of arrhythmia without medication or pacemaker for a mean follow-up period of 23 +/- 13 (2-63) months. Six other patients (15%) were controlled with a previously ineffective medication.
Haissaguerre
M
M
Service de Cardiologie, Hôpital Saint-André, Bordeaux, France.
Warin
J F
JF
D'Ivernois
C
C
Le Métayer
P H
PH
Montserrat
P
P
D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery; D002036:Bundle of His / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*