We describe our experience in catheter ablation (CA) of AV junction in 46 patients (pts) with poorly controlled supraventricular tachyarrhythmias. In order to obtain complete AV block, we employed direct current (DCA) in pts enrolled from 7/87 to 7/90, and radiofrequency current (RFA) or DCA from 8/90 to 10/91. Mean age was 67 ± 10 (range 30-85); organic heart disease was present in 80% of pts. Primary arrhythmia was: atrial fibrillation or flutter (79%); atrial tachycardia (4%); AV nodal reentrant tachycardia (11%); AV reentrant tachycardia (concealed pathway) (6%). 33 pts (72%) were treated with DCA only; 9 pts (19%) with RFA only; 4 pts (9%) with DCA after failed initial RFA. In the first group, persistent complete AV block was achieved in 33/33 pts (100%); in the second group in 8/9 pts (89%); in the third group, the 4 pts in which RFA was initially ineffective were subsequently treated with DCA with 3 success. Overall, the success rate of DCA was 97% (36/37 pts treated with this technique); for RFA, the success rate was 62% (9/13 pts). Complications after DCA include: NSVT (5); hypotension (3); thrombophlebitis (2); SVT (1); acute pulmonary edema (1). No relevant complications were observed after RFA. One in-hospital death occurred in a pt treated with DCA, due to massive pulmonary embolism. In the follow-up (20.4 ± 9.8 mo; range 2-45 mo), 3 deaths were recorded in the DCA group, none of which was arrhythmic or related to the procedure (2 pts died of congestive heart failure, 1 of intracranial hemorrhage). Conclusions: in our experience, DCA is an established method for CA of AV junction; its success rate in producing complete AV block is higher with respect to RFA. On the other hand, RFA entails fewer complications and is recommended as the initial approach in this patients.
|Number of pages||5|
|Journal||New Trends in Arrhythmias|
|Publication status||Published - 1992|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine