Catheter-induced mechanical trauma to fast and slow pathways during radiofrequency ablation of atrioventricular nodal reentry tachycardia: incidence, predictors, and clinical implications.
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.
Topilski
Ian
I
Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv-University, Tel-Aviv, Israel.
Rogowski
Ori
O
Glick
Aharon
A
Viskin
Sami
S
Eldar
Michael
M
Belhassen
Bernard
B
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