Modulation of AV node conduction is effective in most patients as an alternative to His bundle ablation for control of ventricular rate in paroxysmal atrial fibrillation or flutter. No patient had progression to any degree of AV block.Īblation of the slow AV node pathway allows reduction of ventricular rate during atrial fibrillation or flutter while maintaining intact AV conduction during sinus rhythm. During a follow-up period of 5.8 +/- 3.5 months, 11 patients experienced a recurrence of atrial fibrillation at 60 to 95 beats/min. Complete AV block was induced in two patients (transient in one, permanent in one). Mean ventricular rate decreased from 157 +/- 38 to 67 +/- 10 beats/min in two patients with atrial fibrillation. Typical atrial flutter is due to a macrore-entrant circuit within the right atrium and it can be eliminated by a linear lesion in the isthmus between the tricuspid annulus and the vena Radiofrequency catheter ablation is now considered as a curative approach in patients with typical atrial flutter. Mean AV ratio increased from 1.6 +/- 0.5 to 3.0 +/- 0.6 (p = 0.02) in six patients with atrial flutter. A rapid 2:1 atrioventricular conduction during AFL may paradoxically mask a severe underlying Purkinje disease. The anterograde effective refractory period of the AV node was prolonged from 270 +/- 50 (mean +/- SD) to 390 +/- 87 ms (p = 0.005) and the Wenckebach cycle from 346 +/- 33 to 458 +/- 75 ms (p = 0.004) in six patients during sinus rhythm. Radiofrequency current was delivered in six patients during sinus rhythm, in six during atrial flutter and in two during atrial fibrillation. This procedure causes pacemaker dependence.įourteen patients with drug-refractory paroxysmal atrial flutter or fibrillation underwent ablation of the slow AV node pathway. In patients with atrial fibrillation or flutter not amenable to a direct atrial approach, ablation of the His bundle is performed to induce complete AV block. B Ablation resulted in termination of atrial flutter with type I second degree AV nodal block pattern. 1 CTI ablation is associated with a 9297 success rate and a very low complication rate (<1) including atrioventricular block (AVB) (0.4). A Baseline ECG showing atrial flutter with slow ventricular rate. We hypothesized that modulation of atrioventricular (AV) node conduction, allowing a reduction in ventricular rate during atrial fibrillation or flutter without affecting AV conduction during sinus rhythm, might be achieved through ablation of the "slow" AV node pathway. Catheter ablation of the cavotricuspid isthmus (CTI) using radiofrequency energy is currently the first line therapy for symptomatic right atrial flutter (AFL). In the treatment of patients with refractory atrial fibrillation (AF), the safety and efficacy of atrioventricular nodal ablation (AVNA) versus pharmacotherapy alone remains unclear.
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