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How to Approach Difficult Cases of AVNRT

  • Arrhythmia (D Spragg, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Our approach to the ablation of atrioventricular nodal reciprocating tachycardia (AVNRT), the most common supraventricular tachycardia, is as follows: We first attempt ablation in the right atrial posteroseptum anterior to the coronary sinus ostium with a 4-mm non-irrigated tip catheter. If ablation within the triangle of Koch is unsuccessful with radiofrequency (RF), we switch to cryoablation and target a more superior (mid septal) region. We also utilize cryoablation if RF ablation produces transient VA block (absence of retrograde conduction during junctional rhythm) or a fast junctional rhythm (<350 msec). If cryoablation were to fail, or is not available, we would then suggest ablation within the coronary sinus targeting the roof (2–4 cm from the os) using a 3.5-mm irrigated tip catheter. If tachycardia were still inducible despite these measures, we would then proceed with transseptal puncture (given our greater experience with this over a retrograde aortic approach) and perform RF ablation along the posteroseptal left atrium and inferoseptal mitral annulus utilizing an irrigated tip catheter. In our experience, cryoablation reliably results in elimination of the slow pathway. The only left atrial ablation for AVNRT at our institution in the past year was performed because a patent foramen ovale allowed for rapid left atrial access, facilitating left atrial ablation of the slow pathway.

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Authors and Affiliations

  1. Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN62, Portland, OR, 97239, USA

    Darpan S. Kumar MD, Thomas A. Dewland MD, Seshadri Balaji MBBS & Charles A. Henrikson MD

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  1. Darpan S. Kumar MD
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  2. Thomas A. Dewland MD
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Correspondence to Charles A. Henrikson MD.

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Darpan S. Kumar, Thomas A. Dewland, and Charles A. Henrikson each declare no potential conflicts of interest.

Seshadri Balaji reports a research grant from Medtronic for research on pediatric hypertophic cardiomyopathy.

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Kumar, D.S., Dewland, T.A., Balaji, S. et al. How to Approach Difficult Cases of AVNRT. Curr Treat Options Cardio Med 19, 34 (2017). https://doi.org/10.1007/s11936-017-0531-9

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