Radiofrequency modification of atrioventricular junction for atrioventricular nodal reentrant tachycardia (AVNRT)

Gusak V.K., Vatutin N.T., Kuznetsov A.S., Bassov O.I., Kharitonchik D.L.,
Komissarov S.I., Nosenko V.M.

Institute of Urgent & Recovery Surgery Academy of Medical Sciences.
Donetsk, Ukraine

Abstract

Method:17 patients (12 female and 5 male) with average 46± 19 years were operated on with radiofrequency (RF) modification of atrioventricular (AV) junction for AVNRT resistant to antiarrhythmics. All patients had typical form of AVNRT diagnosing with baseliene electrophysiological study. 15 patients had no heart diseases; another had ischemic heart disease. All patients examined with invasive electrophysiological study. Three catheter electrodes situated on high right atrium (HRA), His bundle and right ventricular apex (RVA) were used. AVNRT inducing, ante- and retrograde conduction through atrioventricular node was estimated electrophysiologicaly with atropine and isoproterenol. Ablation catheter pointed on AV junction for primary registration of maximum His bundle potential. Quadpolar 7F steerable catheter Mariner Medtronic with adjustable temperature and power used for ablation. Atakr Medtronic delivered RF power.
Results: Increasing the power gradually from 10 till 35 W we obtain elongation of PR interval for 30-50% from initial or AV block in all patients. 6-31 applications were required. AV conduction increased from 110 till 231 msec. Effect of RF modification were complete when it was impossible to induce AVNRT with atropine and isoproterenol or AV block I has been achieved. AV block III were in 3 patients which required pacemaker implantation. In terms from 12 till 32 months effect were excellent in 14 patients. Two patients were operated on repeatedly for the reason of recurrence of AVNRT after 4 and 7 months.
Conclusion: RF modification of AV junction for treating of AVNRT is the method of choice because of low complications and high efficiency.

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