Symptomatic arrhythmias after catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT): results from the German Ablation Registry
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In atrioventricular nodal reentrant tachycardia (AVNRT), catheter ablation is considered as first-line therapy. Despite high success rates, some patients present with arrhythmia recurrence or develop other types of arrhythmias over time.
To assess the incidence of symptomatic arrhythmias after initially successful AVNRT ablation and to analyze their clinical implications in a real-world cohort.
We included 2,795 patients from the German Ablation Registry undergoing first ablation of AVNRT between 01/2007 and 01/2010. In patients alive at long-term follow-up, patient-specific characteristics and long-term follow-up data were compared between patients with (group A) and without (group B) any symptomatic arrhythmia during follow-up.
Symptomatic arrhythmias occurred in 17.2% of patients during a mean follow-up of 678 days after AVNRT ablation. The patients with symptomatic arrhythmias were more often female and suffered from structural heart disease. Arrhythmia occurrence was clinically relevant regarding symptoms and patient satisfaction. Serious adverse events including stroke, transient ischemic attack, pacemaker implantation, as well as continued use of antiarrhythmic medication occurred more often in group A. A second ablation procedure was performed in 26% of symptomatic patients to optimize the symptomatic outcome, whereas cardiovascular events or patient satisfaction were not further improved.
During long-term follow-up, one out of six patients experienced symptomatic arrhythmias after AVNRT ablation, associated with an increase of serious adverse events. A subset of patients required medical or interventional antiarrhythmic therapy, possibly attributable to the co-existence of other arrhythmias. Screening for arrhythmic and cardiac co-morbidity before and after ablation may support comprehensive therapy planning and outcome.
KeywordsCatheter ablation AVNRT Complications Registry Long-term follow-up
This work was supported by an unrestricted grant from the Stiftung Institut fuer Herzinfarktforschung, Germany. The long-term follow-up and a prior publication were partially supported by unrestricted grants from Medtronic, Biosense Webster, and Biotronik.
Compliance with ethical standards
Conflict of interest
D.T. reports receiving lecture fees/honoraria from Bayer Vital, Boehringer Ingelheim Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer Pharma, Sanofi-Aventis, St. Jude Medical and ZOLL CMS. T.L. reports receiving modest honoraria for lectures by Medtronic, Biotronik, Abbott, Boston Scientific. S.G.S. reports receiving lecture fees from, Medtronic, BMS, Edwards, Pfizer and Sanofi-Aventis, as well as lecture honoraria and travel support from Abbott within the last 24 months. F.S. reports honoraria for lectures from Bristol-Myers Squibb, Daichii Sankyo, I-Med-Pro, Korese, Medtronic, wikonet GmbH, educational and travel support by Pfizer, as well as advisory board activities for Boehringer Ingelheim (last 24 months and outside the submitted work). L.E. reports consultant fees, speaking honoraria, and travel expenses from Abbott, Bayer, Biosense Webster, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer, and Sanofi-Aventis. L.E.’s research has been supported by the German Research Foundation (DFG) and German Heart Foundation outside the submitted work. J.S. and M.H. state that the long-term follow-up and a prior publications were partially supported by unrestricted grants from Medtronic, Biosense Webster and Biotronik.
- 1.Katritsis DG, Zografos T, Katritsis GD, Giazitzoglou E, Vachliotis V, Paxinos G, Camm AJ, Josephson ME (2017) Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace 19:602–606. https://doi.org/10.1093/europace/euw064 CrossRefPubMedGoogle Scholar
- 2.Page RL, Joglar JA, Caldwell MA et al (2016) 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 13:e136–e221. https://doi.org/10.1016/j.hrthm.2015.09.019 CrossRefPubMedGoogle Scholar
- 3.Hoffmann BA, Brachmann J, Andresen D, Eckardt L, Hoffmann E, Kuck KH, Schumacher B, Spitzer SG, Schirdewahn P, Tebbenjohanns J, Horack M, Senges J, Salukhe TV, Rostock T, Willems S (2011) Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry. Heart Rhythm 8:981–987. https://doi.org/10.1016/j.hrthm.2011.02.008 CrossRefPubMedGoogle Scholar
- 4.Reents T, Jilek C, Schuster P, Nölker G, Koch-Büttner K, Ammar-Busch S, Semmler V, Bourier F, Kottmaier M, Kornmayer M, Brooks S, Fichtner S, Kolb C, Deisenhofer I, Hessling G (2017) Multicenter, randomized comparison between magnetically navigated and manually guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia (the MagMa-AVNRT-trial). Clin Res Cardiol 106:947–952. https://doi.org/10.1007/s00392-017-1144-8PMID: 28849269 CrossRefPubMedGoogle Scholar
- 5.Brembilla-Perrot B, Olivier A, Villemin T, Vincent J, Manenti V, Beurrier D, de la Chaise AT, Selton O, Louis P, de Chillou C, Sellal JM (2016) Prediction of atrial fibrillation in patients with supraventricular tachyarrhythmias treated with catheter ablation or not. Classical scores are not useful. Int J Cardiol 220:102–106. https://doi.org/10.1016/j.ijcard.2016.06.103 CrossRefPubMedGoogle Scholar
- 6.Kimman GP, Bogaard MD, van Hemel NM, van Dessel PF, Jessurun ER, Boersma LV, Wever EF, Theuns DA, Jordaens LJ (2005) Ten year follow-up after radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia in the early days forever cured, or a source for new arrhythmias? Pacing Clin Electrophysiol 28:1302–1309. https://doi.org/10.1111/j.1540-8159.2005.00271.x CrossRefPubMedGoogle Scholar
- 8.Fink T, Metzner A, Willems S, Eckardt L, Ince H, Brachmann J, Spitzer SG, Deneke T, Schmitt C, Hochadel M, Senges J, Rillig A (2019) Procedural success, safety and patients satisfaction after second ablation of atrial fibrillation in the elderly: results from the German Ablation Registry. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01471-5 CrossRefPubMedGoogle Scholar
- 9.Frommeyer G, Brachmann J, Ince H, Spitzer SG, Thomas D, Willems S, Schumacher B, Schirdewahn P, Lewalter T, Hochadel M, Senges J, Eckardt L (2019) Digitalis therapy is associated with higher comorbidities and poorer prognosis in patients undergoing ablation of atrial arrhythmias: data from the German Ablation Registry. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01442-w CrossRefPubMedGoogle Scholar
- 10.Eitel C, Ince H, Brachmann J, Kuck KH, Willems S, Gerds-Li JH, Tebbenjohanns J, Richardt G, Hochadel M, Senges J, Tilz RR (2019) Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry. Clin Res Cardiol 108:815–823. https://doi.org/10.1007/s00392-019-01411-3 CrossRefPubMedGoogle Scholar
- 11.Brachmann J, Lewalter T, Kuck KH, Andresen D, Willems S, Spitzer SG, Straube F, Schumacher B, Eckardt L, Danilovic D, Thomas D, Hochadel M, Senges J (2017) Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry. Eur Heart J 38:1317–1326. https://doi.org/10.1093/eurheartj/ehx101 CrossRefPubMedGoogle Scholar
- 12.Deisenhofer I, Zrenner B, Yin YH et al (2010) (2010) Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial. Circulation 122:2239–2245. https://doi.org/10.1161/CIRCULATIONAHA.110.970350 CrossRefPubMedGoogle Scholar
- 13.Wasmer K, Dechering DG, Köbe J, Leitz P, Frommeyer G, Lange PS, Kochhäuser S, Reinke F, Pott C, Mönnig G, Breithardt G, Eckardt L (2017) Patients' and procedural characteristics of AV-block during slow pathway modulation for AVNRT-single center 10year experience. Int J Cardiol 244:158–162. https://doi.org/10.1016/j.ijcard.2017.06.043 CrossRefPubMedGoogle Scholar
- 15.Feldman A, Voskoboinik A, Kumar S, Spence S, Morton JB, Kistler PM, Sparks PB, Vohra JK, Kalman JM (2011) Predictors of acute and long-term success of slow pathway ablation for atrioventricular nodal reentrant tachycardia: a single center series of 1,419 consecutive patients. Pacing Clin Electrophysiol 34:927–933. https://doi.org/10.1111/j.1540-8159.2011.03092.x CrossRefPubMedGoogle Scholar
- 16.Brembilla-Perrot B, Sellal JM, Olivier A, Manenti V, Beurrier D, de Chillou C, Villemin T, Girerd N (2015) Recurrences of symptoms after AV node re-entrant tachycardia ablation: a clinical arrhythmia risk score to assess putative underlying cause. Int J Cardiol 179:292–296. https://doi.org/10.1016/j.ijcard.2014.11.071 CrossRefPubMedGoogle Scholar
- 17.Hasdemir C, Payzin S, Kocabas U, Sahin H, Yildirim N, Alp A, Aydin M, Pfeiffer R, Burashnikov E, Wu Y, Antzelevitch C (2015) High prevalence of concealed Brugada syndrome in patients with atrioventricular nodal reentrant tachycardia. Heart Rhythm 12:1584–1594. https://doi.org/10.1016/j.hrthm.2015.03.015 CrossRefPubMedGoogle Scholar
- 18.Farkowski MM, Pytkowski M, Maciag A, Golicki D, Wood KA, Kowalik I, Kuteszko R, Szwed H (2014) Gender-related differences in outcomes and resource utilization in patients undergoing radiofrequency ablation of supraventricular tachycardia: results from Patients' Perspective on Radiofrequency Catheter Ablation of AVRT and AVNRT Study. Europace 16:1821–1827. https://doi.org/10.1093/europace/euu130 CrossRefPubMedGoogle Scholar
- 19.Zylla MM, Brachmann J, Lewalter T, Hoffmann E, Kuck KH, Andresen D, Willems S, Eckardt L, Tebbenjohanns J, Spitzer SG, Schumacher B, Hochadel M, Senges J, Katus HA, Thomas D (2016) Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry. Heart Rhythm 13:1837–1844. https://doi.org/10.1016/j.hrthm.2016.06.005 CrossRefPubMedGoogle Scholar
- 21.Roten L, Rimoldi SF, Schwick N, Sakata T, Heimgartner C, Fuhrer J, Delacrétaz E, Tanner H (2009) Gender differences in patients referred for atrial fibrillation management to a tertiary center. Pacing Clin Electrophysiol 32:622–626. https://doi.org/10.1111/j.1540-8159.2009.02335.x CrossRefPubMedGoogle Scholar