title: Catheter-induced mechanical trauma to fast and slow pathways during radiofrequency ablation of atrioventricular nodal reentry tachycardia: incidence, predictors, and clinical implications.
abstract: BACKGROUND
  Data on the incidence and significance of catheter-induced trauma to fast and slow pathways are scarce.
  
  
  OBJECTIVE
  To evaluate the incidence, predictors, and clinical implications of inadvertent catheter-induced mechanical trauma to fast and slow pathways during radiofrequency ablation (RFA) of atrioventricular nodal reentry tachycardia (AVNRT).
  
  
  METHODS
  A total of 901 consecutive patients (aged 9-92 years old) with inducible sustained AVNRT underwent RFA of the slow pathway. All procedures were closely monitored for appearance of catheter-induced mechanical block of fast or slow pathways.
  
  
  RESULTS
  Catheter-induced mechanical trauma to fast and/or slow pathways was observed in 121 (13.4%) patients: 86 (71%) patients had trauma of the fast pathway, three (2.4%) had trauma of the slow pathway, and 32 (26.4%) had trauma of both pathways. Mechanical trauma lasted <1 minute in 87 (72%) patients, 1-30 minutes in 23 (19%) and >30 minutes in 11 (9%). A significantly increased procedure discontinuation rate was observed in patients with mechanical trauma as compared to those with no trauma (P < 0.0001). Young patient age (<35) was a strong predictor for the occurrence of mechanical trauma to AV nodal pathways. No significant difference between the trauma and non-trauma groups was found in respect to the number of catheters used during the procedure, the incidence of AV block, and the need for permanent pacemaker implantation.
  
  
  CONCLUSIONS
  Mechanical trauma to fast and slow pathways during ablation of AVNRT is more common than previously recognized, occurring especially in patients aged <35 years.
authors: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv-University, Tel-Aviv, Israel.
authors: Ian
authors: I
authors: Topilski
authors: Ori
authors: O
authors: Rogowski
authors: Aharon
authors: A
authors: Glick
authors: Sami
authors: S
authors: Viskin
authors: Michael
authors: M
authors: Eldar
authors: Bernard
authors: B
authors: Belhassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001283:Atrioventricular Node / Q000293:injuries; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D002404:Catheterization; D002648:Child; D004594:Electrophysiology; D005260:Female; D006329:Heart Conduction System / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D016896:Treatment Outcome