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Persistence of Palpitations After Slow Pathway Modification for AVNRT in Young People

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Abstract

Symptoms are the most common indication for ablation in children with atrioventricular nodal reentrant tachycardia (AVNRT). After the procedure, patients may continue to report palpitations. The objective of this study was to quantify the risk and duration of palpitations after pediatric slow pathway modification as well as demographic and technical associations. This was a retrospective review of consecutive patients at a pediatric center who underwent slow pathway modification for AVNRT from 2012 to 2018. Patients with a prior ablation attempt or congenital heart disease were excluded. Palpitations were documented in 35% of patients after ablation. Neither post-ablation echo beats nor other evidence of residual dual AV nodal physiology were associated with a higher risk of post-ablation palpitations. Of the 35 patients with post-ablation palpitations, the median time to resolution of palpitations was 48 months. Acute procedural success was achieved in all 100 cases. There were two recurrences of AVNRT during long-term follow-up and one instance of ectopic atrial tachycardia (3% SVT recurrence). Palpitations after AVNRT ablation occurred in approximately one-third of cases, despite a low recurrence of true arrhythmia. Prior to ablation, patients and families should be counseled that post-ablation palpitations are common and AVNRT recurrence is rare.

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Funding

This work was supported by the National Institutes of Health, National Heart, Lung and Blood Institute, Grant Number K23HL130554; REDCap access was provided by Northwestern University Clinical and Translational Sciences Institute, funded in part by NIH UL1TR001422.

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Authors and Affiliations

  1. Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL, 60611, USA

    Thomas Carberry, Sabrina Stanley, Ahmad Sami Chaouki, Lajja Desai, Sabrina Tsao, Kendra Ward & Gregory Webster

  2. Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL, USA

    Lauren C. Balmert

Authors
  1. Thomas Carberry
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  2. Lauren C. Balmert
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  3. Sabrina Stanley
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  4. Ahmad Sami Chaouki
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  5. Lajja Desai
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  6. Sabrina Tsao
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  7. Kendra Ward
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  8. Gregory Webster
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TC, SS, LD, and GW. Invasive data collection and analysis were performed by TC, SC, ST, and GW. The first draft of the manuscript was written by TC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Thomas Carberry.

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The authors have no conflicts of interest to report.

Ethical Approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted with the IRB of Ann & Robert H. Lurie Children’s Hospital of Chicago who determined that our study did not need ethical approval.

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Carberry, T., Balmert, L.C., Stanley, S. et al. Persistence of Palpitations After Slow Pathway Modification for AVNRT in Young People. Pediatr Cardiol 42, 590–596 (2021). https://doi.org/10.1007/s00246-020-02519-4

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  • DOI: https://doi.org/10.1007/s00246-020-02519-4

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