Author + information
- Received July 8, 1992
- Revision received November 9, 1992
- Accepted December 22, 1992
- Published online June 1, 1993.
- Delon Wu, MD, FACC∗,
- San-Jou Yeh, MD,
- Chun-Chieh Wang, MD,
- Ming-Shien Wen, MD and
- Fun-Chung Lin, MD
- ↵∗Address for correspondence: Delon Wu, MD, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan.
Objectives. A simple technique was designed for radiofrequency ablation therapy of atrioventricular (AV) node reentrant tachycardia.
Background. This technique was based on the hypothesis that slow pathway conduction reflects conduction through the compact node and its posterior atrial input.
Methods. A total of 100 consecutive patients were studied; there were 37 men and 63 women, with a mean age of 48 ± 15 years. All 100 patients had induction of sustained tachycardia with (51 patients) or without (49 patients) administration of isoproterenol or atropine, or both. The ablation catheter was initially manipulated to record the largest His bundle deflection from the apex of Koch's triangle. It was then curved downward and clockwise to the area of the compact node when His deflection was no longer visible and the ratio of atrial to ventricular electrogram was < 1. The radiofrequency current was delivered from the 4-mm tip electrode a mean of 5 ± 7 times at a power of 25 ± 4 W for a duration of 21 ± 4 s. The total fluoroscopic time was 19 ± 11 min.
Results. Selective ablation (56 patients) or modification (26 patients) of the slow pathway without affecting anterograde and retrograde fast pathway conduction was achieved in 82 patients. Ablation or modification of both the retrograde fast pathway and the slow pathway but with preservation of anterograde fast pathway conduction was noted in 12 patients. Ablation or modification of the retrograde fast pathway alone or both anterograde and retrograde fast pathway conduction was noted in three patients. Complete AV node block occurred in three patients. Seventy-three patients had no induction of echo beats or tachycardia and 24 patients had induction of a single echo beat after ablation. Follow-up study was performed in 62 patients 76 ± 18 days after ablation. Thirty-nine patients had no induction of echo beats or tachycardia, 22 had induction of echo beats alone and 1 patient had induction of sustained tachycardia.
Conclusion. Selective ablation of the slow AV node pathway can be achieved by a simple procedure with a high success rate and few complications.
☆ This study was supported in part by Grants NSC81-0412-B182-523 and NSC81-0412-B182-14 from the National Science Council and Grant DOH82-HR-C05 from the National Health Institutes of the Republic of China, Taipei.
- Received July 8, 1992.
- Revision received November 9, 1992.
- Accepted December 22, 1992.