Catheter ablation of atrioventricular nodal reentry tachycardia – non invasive possibility of diagnostics, immediate and 1 year results following radiofrequency ablation and 1 year follow up of 40 patients treated in 2002


Authors: Y. Staňková 1;  J. Müllerová 1;  Z. Stárek 1;  P. Vank 2;  L. Zaoral 1;  M. Novák 1
Authors‘ workplace: I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC 1;  Klinika funkční diagnostiky a rehabilitace Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Jarmila Siegelová, DrSc. 2
Published in: Vnitř Lék 2005; 51(5): 539-547
Category: Original Contributions

Overview

Introduction:
Catheter radiofrequency ablation (RFA) of atrioventricular nodal reentry tachycardia (AVNRT) is the method of first selection in patients with symptomatic tachycardia. 

Aim:
Our target was to prove the yield of non-invasive investigative methods in the course of AVNRT diagnosis, to observe success of method and quality of life improvement after the RFA, X-rays stress, the number of RFA applications, time of skiascopy and effort time, complications of RFA and to compare exercise tolerance before and after the RFA. 

Patients and methods:
40 patients with the diagnosis of AVNRT who underwent RFA from January 1, 2002 till December 31, 2002 in Faculty Hospital St. Ann, Brno, CZ, were evaluated. Before we°ve done EP study, we made clinical investigation, ECG, Holter monitoring, oesophageal atrial stimulation, bicycle ergometry, echocardiography. All investigation, were repeated after the RFA, except oesophageal atrial pacing. 

Results:
Tachycardia was not found during bicycle ergometry in any patient. Tachycardia was recorded in 9 (24.3%) cases of 37 patients during 24hour Holter monitoring. Clinical tachycardia was recalled in 21 (65.6%) of 32 patients during oesophageal stimulation and in 37 (92.5%) of 40 patients during the EP study. Average number of radiofrequency energy applications to the patient was 11.1 ± 7.5 (1–38), skiascopic time was 12.5 ± 7.8 (3–43) minutes; average effort time was 145.9 ± 44.3 (90–260) minutes. Complications occurred in 2 cases (5.0%) – transient 1st degree atrioventricular block once and pneumothorax on the left side once. After the RFA, the exercise tolerance increased of 0.5 W.kg–1 in 16 of 36 patients tested (44.4%). Immediate success rate of RFA for AVNRT was 100%. From the group of 40 followed patients, relapse occurred in 3 (7.5%) patients during one year follow-up (successful reablation performed once, good effect of verapamil once, reablation refused once). So, without tachycardia in one year follow-up was 97.4% of patients in our group. One year after RFA, 38 from 39 (97.4%) living patients determine life quality improvement. 

Conclusion:
For diagnosis and successful therapy of AVNRT is important recording of the arrhythmia. From non-invasive methods ECG and Holter monitoring are useful. Bicycle ergometry has not got practical importance. More important in diagnostic process is semi– invasive oesophageal atrial stimulation. The precious diagnosis and arrhythmia management is done by EP study with RFA. After the successful RFA, the efficiency grew in half of patients – we suppose removing psychical inhibition. Results of RFA at our workplace are comparable to the published results.

Key words:
catheter radiofrequency ablation – atrioventricular nodal reentry tachycardia – bicycle ergometry – Holter monitoring – oesophageal atrial stimulation


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