Long-Term Follow-Up of Empirical Slow Pathway Ablation in Pediatric and Adult Patients with Suspected AV Nodal Reentrant Tachycardia

Background: Aim of this study was to assess long-term efficacy and safety of empirical slow pathway (ESP) ablation in pediatric and adult patients with a special interest in patients without dual AV nodal physiology (DAVNP).

Methods: A retrospective single-center review of patients who underwent ESP ablation between December 2014 and September 2022 was performed. Follow- up included telephone communication, letter questionnaire and clinic visits. Recurrence was based on typical symptoms.

Results: A total of 115 patients aged 6–81 years (median age 36.33 ± 18.91 years, 59.1% female; 26 pts <18 years of age) underwent EP study and ESP ablation. A typical history of paroxysmal tachycardia was present in all 115 patients (100%) and 97 patients (84%) had an ECG documentation of narrow complex tachycardia. In 6 patients (5.3%), a prior EP study had been performed without ablation. Patients were divided into 3 groups: Group 1 (n = 23 pts. without DAVNP or AV nodal echo beat), Group 2 (n = 30 pts. with AH jump without AV nodal echo beat) and Group 3 (n = 62 pts. with AH jump and at least one AV nodal echo beat). An ESP ablation was performed in all patients. One major complication (pericardial effusion) occurred in Group 3 that was managed by pericardiocentesis. No AV block occurred. During a median follow-up of 23.67 ± 22.7 months, recurrence of symptoms occurred in only 7/115 patients (6.1%). Kaplan-Meier analysis shows freedom from symptoms after ablation without significant difference between the 3 groups (p = 0.73, log-rank test). Symptom recurrence was higher in patients without prior ECG documentation (5/18 patients; 27%) than in patients with pre-ablation ECG documentation (2/97 patients; 2.1%; p = 0.025). Pearson’s correlation coefficient shows no statistical relationship between younger age and longer RF time (r = 0.03) and no correlation between age and success rate of ESP ablation (p > 0.1) was found. All 26 pediatric patients and the 6 patients with prior EP study remained free from symptom recurrence.

Conclusion: ESP ablation can be performed effectively and safely in patients with documented or suspected AVNRT that is non-inducible at the EP study. Recurrence of symptoms during long-term follow-up after ESP is low, even if no dual AV nodal physiology is revealed at the EP study.

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Artikel online veröffentlicht:
13. Februar 2024