Meta-analysis to assess the appropriate endpoint for slow pathway ablation of atrioventricular nodal reentrant tachycardia.
BACKGROUND
There are little data on the appropriate endpoint for slow pathway ablation that balances acceptable procedural times, recurrence rates, and complication rates. This study compared recurrence rates of three commonly utilized endpoints of slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT).


METHODS
We performed a meta-analysis of AVNRT slow pathway ablation cohorts by searching electronic databases, the Internet, and conference proceedings. Inclusion criteria were age >18 years, >20 human subjects per study, primary AVNRT ablation, English language publication, and >1 month of follow-up. Data were analyzed with a fixed-effects model using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA).


RESULTS
We included 10 studies encompassing 1,204 patients with a mean age of 41-53 years. Endpoints were complete slow pathway ablation, residual jump only, and single remaining echo beat. Pooled estimates revealed 28 of 641 patients (4.4%) with complete slow pathway ablation, 13 of 192 patients (6.8%) with a residual jump only, and 24 of 371 patients (6.5%) with one echo had recurrences. With uniform isoproterenol use after ablation, there was no significant difference in recurrence rates among the endpoints. However, when isoproterenol was utilized after ablation only if needed to induce AVNRT before ablation, a significantly higher recurrence rate occurred in patients with a residual jump (P = 0.002), a single echo (P = 0.003), or the combined group of a residual jump and/or one echo (P = 0.001).


CONCLUSIONS
Isoproterenol should be used routinely after slow pathway modification, when a residual jump and/or single echo remain.
Leon H. Charney Heart Rhythm Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York 10016, USA.
Joshua D
JD
Stern
Linda
L
Rolnitzky
Judith D
JD
Goldberg
Larry A
LA
Chinitz
Douglas S
DS
Holmes
Neil E
NE
Bernstein
Scott A
SA
Bernstein
Paul
P
Khairy
Anthony
A
Aizer
D000328:Adult; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome