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

Česká verzia

Authors: Y. Staňková ¹; J. Müllerová ¹; Z. Stárek ¹; P. Vank ²; L. Zaoral ¹; M. Novák ¹
Authors place of work: 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 the journal: Vnitř Lék 2005; 51(5): 539-547
Category: Original Contributions

Summary

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 1^st 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

Zdroje

1. Barsky AJ, Cleary PD, Barnett MC et al. The accuracy of symptoms reporting by patients complaining of palpitations. Amer J Med 1994; 97: 214–221.

2. Calkins H, Niklason L, Sousa J et al. Radiation exposure during radiofrequenc catheter ablation of accesory atrioventricular connections. Circulation 1991; 84: 2376–2382.

3. Calkins H, Yong P, Miller JM et al. for the Atakr Multicenter Investigators Group: Catheter ablation of accessory pathways, atrioventricular nodal reentry tachycardia, and the atrioventricular junction: final result of a prospective, multicenter clinical trial. Circulation 1999; 99: 262–270.

4. Capatto R, Kuck KH. Catheter ablation in the year 2000. Curr Opin Cardiol 2000; 15: 29–40.

5. Čihák R. Registr radiofrekvečních ablací. II. české a slovenské sympozium o arytmiích a kardiostimulaci. Jeseník, leden 2004.

6. Fiala M, Lukl J, Heinc P. Selektivní radiofrekvenční ablace atrioventrikulární nodální reentry tachykardie. In: Lukl J et al. Srdeční arytmie – aktuální problémy. Praha: Grada 1996: 232.

7. Fujiseki Y, Fujino H, Hattori M et al. Mechanisms of supraventricular tachyarrhitmias in infants and children – transesophageal pacing study. PACE 1987; 10: 1001.

8. Gallagher JJ, Smith WM, Kassel J et al. Use of esophageal lead in the diagnosis of mechanisms of reciprocating supraventricular tachycardia. PACE 1980; 3: 440–451.

9. Kopp DE, Wilber D. Palpitations and arrhytmias. Postgrad Med 1992; 91: 241–251.

10. Kovoor P, Ricciardello K, Uther JB. Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. Circulation 1998; 98: 1534–1540.

11. Čihák R, Bytešník J, Heřman D et al. Katetrizační ablace arytmií radiofrekvenčním proudem v České republice v roce 1998. In: Lukl J, Heinc P et al. Moderní léčba arytmií. Praha: Grada 2001: 212.

12. Sganzerela P, Fabbiocchi F, Grazi C et al. Electrophysiologic and hemodynamic correlates in supraventricular tachycardia. Eur Heart J 1989; 10: 32–39.

13. Sharma AD, Yee R, Guirodon G et al. Sensitivity and specifity of invasive and noninvasive testing for risk of sudden death in Wolf-Parkinson-White syndrom. J Amer Coll Cardiol 1987; 10: 373.

14. Scheinman MM. North American Society of Pacing and Electrophysiology (NASPE) survey on radiofrequency catheter ablation: Implications for clinicians, third party insurers and government regulatory agencies. PACE 1992; 15: 2228–2231.

15. Sovová E, Doupal J, Lukl J. Holterova monitorace EKG při vyšetřování srdečních arytmií včera, dnes a zítra. Vnitř Lék 2001; 47: 699–704.

16. Štípal R. Diagnostická jícnová stimulace levé síně srdeční u nemocných s anamnézou bušení srdce. Prakt Lék 1990; 70: 712–714.

17. Štípal R. Diagnostické a terapeutické možnosti jícnové stimulace síní u nemocných se supraventrikulárními arytmiemi. In: Lukl J et al. Srdeční arytmie – aktuální problémy. Praha: Grada 1996:

228.

18. Widimský J, Lefflerová K. Zátěžové EKG testy. Praha: Triton 2000: 106.