title: Impact of Tricuspid Regurgitation on the Success of Atrioventricular Node Ablation for Rate Control in Patients With Atrial Fibrillation: The Node Blast Study.
abstract: Atrioventricular node (AVN) ablation is an effective treatment for symptomatic patients with atrial arrhythmias who are refractory to rhythm and rate control strategies where optimal ventricular rate control is desired. There are limited data on the predictors of failure of AVN ablation. Our objective was to identify the predictors of failure of AVN ablation. This is an observational single-center study of consecutive patients who underwent AVN ablation in a large academic center. Baseline characteristics, procedural variables, and outcomes of AVN ablation were collected. AVN "ablation failure" was defined as resumption of AVN conduction resulting in recurrence of either rapid ventricular response or suboptimal biventricular pacing. A total of 247 patients drug refractory AF who underwent AVN ablation at our center with a mean age of 71 ± 12 years with 46% being males were included. Ablation failure was seen in 11 (4.5%) patients. There were no statistical differences between patients with "ablation failure" versus "ablation success" in any of the baseline clinical variables. Patients with moderate-to-severe tricuspid regurgitation (TR) were much more likely to have ablation failure than those with ablation success (8 [73%] vs 65 [27%]; p = 0.003). All 11 patients with ablation failure had a successful redo procedure, 9 with right and 2 with the left sided approach. On multivariate analysis, presence of moderate-to-severe TR was found to be the only predictor of failure of AVN ablation (odds ratio 9.1, confidence interval 1.99 to 42.22, p = 0.004). In conclusion, moderate-to-severe TR is a strong and independent predictor of failure of AVN ablation.
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: Division of Cardiovascular medicine, Case Western Reserve University, Metrohealth Campus, Cleveland, Ohio.
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.affiliation: Division of Cardiovascular medicine, Creighton University, Omaha, Nebraska.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Emert
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Rhea
authors.initials: R
authors.lastname: Pimentel
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Dendi
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
authors.forename: Loren D
authors.initials: LD
authors.lastname: Berenbom
authors.affiliation: Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D058406:Cardiac Resynchronization Therapy; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications*