Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study.

Journal: Clinical Research In Cardiology : Official Journal Of The German Cardiac Society
Treatment Used: Catheter Ablation
Number of Patients: 17
Published:
MediFind Summary

Summary: This study evaluated the effectiveness of catheter ablation (procedure where a tube is guided into the heart to destroy small areas of tissue that may be causing an abnormal heartbeat) in patients with supraventricular tachycardia (abnormally fast heartbeat) and dual antegrade conduction (double ventricular response to a single atrial impulse) via the atrioventricular (AV) node (part of the electrical conduction system of the heart).

Conclusion: Catheter ablation (procedure where a tube is guided into the heart to destroy small areas of tissue that may be causing an abnormal heartbeat) is safe and effective with good long-term patient outcomes in patients with supraventricular tachycardia (abnormally fast heartbeat) and dual antegrade conduction (double ventricular response to a single atrial impulse) via the atrioventricular node (part of the electrical conduction system of the heart).

Abstract

Background: Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node.

Results: In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months).

Conclusions: This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.

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