title: Transient proarrhythmic state following atrioventricular junction radiofrequency ablation: pathophysiologic mechanisms and recommendations for management.
abstract: The induction of complete heart block by radiofrequency ablation of the atrioventricular junction combined with pacemaker implantation has become an established therapy for rate control in patients with atrial fibrillation who are unresponsive to drugs. Reports of ventricular arrhythmias and sudden death after ablation have, however, raised concerns about safety. Ventricular arrhythmias are usually polymorphic and related to a phase of electrical instability due to an initial prolongation and then slow adaptation of repolarization caused by the change in heart rate and activation sequence. Structural heart disease, and other factors that predispose for the acquired long QT syndrome, seem to add to the risk. Ventricular activation and repolarization stabilize during the first week after the procedure. Routine pacing at 80 beats per minute during this phase is recommended, as well as in hospital monitoring for at least 48 hours. Patients with high-risk features for arrhythmias, such as congestive heart failure or impaired left ventricular function, may require pacing at higher rates. Adjustment of the pacing rate-although rarely below 70 beats per minute-is usually undertaken after a week in most patients, preferably after an electrocardiographic evaluation for repolarization abnormalities at the lower rate.
authors.affiliation: Department of Cardiology, Karolinska Institutet at Karolinska Hospital, S-171 76 Stockholm, Sweden
authors.forename: Karolina
authors.initials: K
authors.lastname: Nowinski
authors.forename: Fredrik
authors.initials: F
authors.lastname: Gadler
authors.forename: Mats
authors.initials: M
authors.lastname: Jensen-Urstad
authors.forename: Lennart
authors.initials: L
authors.lastname: Bergfeldt
mesh_terms: D001283:Atrioventricular Node / Q000503:physiopathology*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017410:Practice Guidelines as Topic; D017180:Tachycardia, Ventricular / Q000150:complications / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy