Sinus arrest during radiofrequency ablation of the atrioventricular-node slow pathway: implications and possible mechanisms.
Radiofrequency ablation has been associated with changes in autonomic function. In this case, a 52-year-old woman was referred for electrophysiologic study of recurrent supraventricular tachycardia. Typical slow/fast atrioventricular node re-entry tachycardia was induced and confirmed during the study. Radiofrequency ablation of the slow pathway of the atrioventricular node led to sinus arrest, which resolved once ablation was stopped. Given the distance of the ablation site from the sinus node, we inferred that mechanisms other than direct injury to the sinus node were involved. To our knowledge, this is only the 2nd reported finding of sinus arrest during slow-pathway ablation of the atrioventricular node. This case highlights the complex interaction between the autonomic nervous system and the cardiac conduction system. Possible mechanisms include a Bezold-Jarisch reflex and modification of the intrinsic autonomic nervous system.
Mathuria
Nilesh
N
Department of Cardiology & Electrophysiology, Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas 77030, USA. nileshmathuria@gmail.com
Bobek
Jaromir
J
Afshar
Hamid
H
D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D001341:Autonomic Nervous System / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012018:Reflex; D054138:Sinus Arrest, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome