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Ventricular versus atrial side ablation for treatment of atrioventricular accessory pathways: a randomized controlled clinical trial

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The earliest atrial (A)/ventricular (V) activation potentials, or fused A/V potentials, are commonly used as ablation targets for atrioventricular (AV) accessory pathways (APs). However, these targets can be achieved in a relatively wide area of the heart around AV rings at both atrial and ventricular sides. The aim of this study is to analyze the height of intracardiac A and V waves and their correlation to find the most appropriate side for successful delivery of radiofrequency energy, atrial or ventricular edge.

Methods

Ninety patients diagnosed with orthodromic AV re-entrant tachycardia (AVRT) or Wolff–Parkinson–White syndrome were enrolled. Local atrial/ventricular (A/V) amplitude potentials with the earliest activation or fused AV potentials were measured. Patients were randomly assigned into two groups with a 2:1 ratio. In group 1, ablation was done at the site where A was greater than V. In group 2, V was greater than A. Primary endpoint was success at first attempt, achieving antegrade AP conduction block, AV block during right ventricle pacing, or AVRT termination with no AP conduction.

Results

Fifty-one patients (56.7%) were male. Thirty patients had an ablation at an atrial site (A > V) and 60 at a ventricular site (V > A). Ablation was more successful at the ventricular site (87% vs 100%, P = 0.011). All 30 patients in the atrial arm and 71% of the ventricular group underwent ablation via the antegrade method.

Conclusions

Success of catheter ablation of APs is higher where V > A (ventricular site of AP), indicating the priority of the ventricular edge of the mitral ring for a better outcome.

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Funding

The present study was financially supported by the grant number 17195 from Vice-Chancellor of Research from the Shiraz University of Medical Sciences.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Hossein Nikoo

  2. Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Hossein Nikoo

  3. Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Hossein Nikoo

  4. Students’ Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

    Meghdad Khorshidifar & Fatemeh Nouri

  5. School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Elham Nasrollahi & Yaser Bahramvand

  6. Department of Cardiovascular Medicine, TAHA Clinical Trial Group, School of Medicine, Shiraz University of Medical Sciences, 71344-1864, Shiraz, Iran

    Armin Attar

Authors
  1. Mohammad Hossein Nikoo
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  2. Meghdad Khorshidifar
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  3. Elham Nasrollahi
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  4. Yaser Bahramvand
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  5. Fatemeh Nouri
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  6. Armin Attar
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Correspondence to Armin Attar.

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IR.SUMS.MED.REC.1398.064 and IRCT20200328046883N.

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Consent was taken from all participants.

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The authors declare no competing interests.

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Nikoo, M.H., Khorshidifar, M., Nasrollahi, E. et al. Ventricular versus atrial side ablation for treatment of atrioventricular accessory pathways: a randomized controlled clinical trial. J Interv Card Electrophysiol 64, 103–110 (2022). https://doi.org/10.1007/s10840-021-01100-0

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  • DOI: https://doi.org/10.1007/s10840-021-01100-0

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