TY - JOUR
T1 - Radiofrequency catheter ablation of the atrioventricular junction from the left ventricle
AU - Sousa, Joäo
AU - El-Atassi, Rafel
AU - Rosenheck, Shimon
AU - Calkins, Hugh
AU - Langberg, Jonathan
AU - Morady, Fred
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1991/8
Y1 - 1991/8
N2 - Background. The purpose of this study was to describe a new technique for catheter ablation of the atrioventricular junction using radiofrequency energy delivered in the left ventricle. Methods and Results. Catheter ablation of the atrioventricular (AV) junction using a catheter positioned across the tricuspid annulus was unsuccessful in eight patients with a mean±SD age of 51±19 years who had AV nodal reentry tachycardia (three patients), orthodromic tachycardia using a concealed midseptal accessory pathway, atrial tachycardia, atrial flutter (two patients), or atrial fibrillation. Before attempts at catheter ablation of the AV junction, each patient had been refractory to pharmacological therapy, and four had failed attempts at either catheter modification of the AV node using radiofrequency energy or surgical and catheter ablation of the accessory pathway. Conventional right-sided catheter ablation of the AV junction using radiofrequency energy in six patients and both radiofrequency energy and direct current shocks in two patients was ineffective. The mean amplitude of the His bundle potential recorded at the tricuspid annulus at the sites of unsuccessful AV junction ablation was 0.1±0.08 mV, with a maximum His amplitude of 0.03-0.28 mV. A 7F deflectable-tip quadripolar electrode catheter with a 4-mm distal electrode was positioned against the upper left ventricular septum using a retrograde aortic approach from the femoral artery. Third-degree AV block was induced in each of the eight patients with 20-36 W applied for 15-30 seconds. The His bundle potential at the sites of successful AV junction ablation ranged from 0.06 to 0.99 mV, with a mean of 0.27±0.32 mV. There was no rise in the creatine kinase-MB fraction and no complications occurred. An intrinsic escape rhythm of 30-60 beats/min was present in seven of the eight patients. Each patient received a permanent pacemaker and has been asymptomatic during 3-13 months of follow-up. Conclusions. Catheter ablation of the AV junction can be achieved effectively and safely using radiofrequency energy delivered in the left ventricle when the conventional right-sided approach is unsuccessful.
AB - Background. The purpose of this study was to describe a new technique for catheter ablation of the atrioventricular junction using radiofrequency energy delivered in the left ventricle. Methods and Results. Catheter ablation of the atrioventricular (AV) junction using a catheter positioned across the tricuspid annulus was unsuccessful in eight patients with a mean±SD age of 51±19 years who had AV nodal reentry tachycardia (three patients), orthodromic tachycardia using a concealed midseptal accessory pathway, atrial tachycardia, atrial flutter (two patients), or atrial fibrillation. Before attempts at catheter ablation of the AV junction, each patient had been refractory to pharmacological therapy, and four had failed attempts at either catheter modification of the AV node using radiofrequency energy or surgical and catheter ablation of the accessory pathway. Conventional right-sided catheter ablation of the AV junction using radiofrequency energy in six patients and both radiofrequency energy and direct current shocks in two patients was ineffective. The mean amplitude of the His bundle potential recorded at the tricuspid annulus at the sites of unsuccessful AV junction ablation was 0.1±0.08 mV, with a maximum His amplitude of 0.03-0.28 mV. A 7F deflectable-tip quadripolar electrode catheter with a 4-mm distal electrode was positioned against the upper left ventricular septum using a retrograde aortic approach from the femoral artery. Third-degree AV block was induced in each of the eight patients with 20-36 W applied for 15-30 seconds. The His bundle potential at the sites of successful AV junction ablation ranged from 0.06 to 0.99 mV, with a mean of 0.27±0.32 mV. There was no rise in the creatine kinase-MB fraction and no complications occurred. An intrinsic escape rhythm of 30-60 beats/min was present in seven of the eight patients. Each patient received a permanent pacemaker and has been asymptomatic during 3-13 months of follow-up. Conclusions. Catheter ablation of the AV junction can be achieved effectively and safely using radiofrequency energy delivered in the left ventricle when the conventional right-sided approach is unsuccessful.
KW - Atrioventricular block
KW - Brief Rapid Communication
KW - Catheter ablation
KW - Radiofrequency energy
UR - http://www.scopus.com/inward/record.url?scp=0025848090&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025848090&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.84.2.567
DO - 10.1161/01.CIR.84.2.567
M3 - Article
C2 - 1860201
AN - SCOPUS:0025848090
SN - 0009-7322
VL - 84
SP - 567
EP - 571
JO - Circulation
JF - Circulation
IS - 2
ER -