AV‐node isolation as an alternative to AV‐node ablation in patients undergoing pace & ablate strategy. (19th October 2022)

• Record Type: Journal Article
• Authors: Lemke, Lisa; El Hamriti, Mustapha; Braun, Martin; Baridwan, Nafilah; Sciacca, Vanessa; Fink, Thomas; Khalaph, Moneeb; Guckel, Denise; Eitz, Thomas; Sohns, Christian; Sommer, Philipp; Imnadze, Guram
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 33:Number 12(2022)
• Page Start: 2606
• Page End: 2613
• Publication Date: 2022-10-19
• Subjects: atrial fibrillation -- AV node ablation -- pace and ablate strategy -- radiofrequency ablation; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15699
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: Atrioventricular (AV)‐node ablation (AVNA) is a common therapy option for rate control strategy of permanent atrial fibrillation (AF). We hypothesized that isolation of the AV nodal isolation (AVNI) is associated with a more frequent preservation of an adequate escape rhythm compared to AVNA. Methods: This retrospective study included 20 patients with therapy‐refractory AF being treated with AVNI and 40 historical AVNA‐controls. In AVNI the AV‐node region was mapped using a 3D mapping system. Ablation was performed around the previously mapped HIS‐cloud regions isolating the atrium from the AV‐node. In the AVNI group, ablation was performed with irrigated tip ablation catheter in all cases. The two approaches were compared regarding rate of escape rhythm, delta QRS, and procedural data. Results: The number of patients with adequate escape rhythm in AVNI was significantly superior to AVNA immediately postoperative (90% vs. 40%, p < 0.01) and during follow‐up (77% vs. 36%, p < 0.05). The median change in QRS width was 0 ms in AVNI versus +26 ms in AVNA ( p < 0.01). Thirty percent new bundle branch blocks in AVNA were observed compared to 0% in AVNI ( p < 0.01). In the AVNI group, fluoroscopy time and total dose area product were significantly lower ( p < 0.01). Conclusion: The present study suggests that AV‐node isolation using 3D navigation mapping system is a feasible and effective alternative to conventional AVNA. The precise application of radiofrequency lesions preserves a stable AV‐junctional rhythm.