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AV Nodal Reentrant Tachycardia Ablation Without Fluoroscopy

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Cardiac Electrophysiology Without Fluoroscopy

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Abstract

The AV nodal reentrant tachycardia (AVNRT) is, for the vast majority of EP labs around the world, the most common arrhythmia substrate to ablate; if it is true that little fluoroscopy is needed to ablate a slow pathway, as the number of cases outweighs by far more complex substrates (where fluoroscopy reduction could have a greater individual exposure impact), starting a fluoroscopy-free approach should start in everyday cases, to then move to complex arrhythmias.

The amount of exposure to fluoroscopy is highly dependent on multiple variables, such as operator experience and complexity of the arrhythmia substrate. As exposure to radiation during such procedures increases the lifetime risk of fatal malignancies, skin injuries, and cataract, it poses a palpable hazard to both patients and medical staff.

We hope at the end of this chapter to have convinced the readers that there are only advantages to the use of 3D mapping systems to ablate any AVNRT. We present the data with emphasis on how to perform a procedure without fluoroscopy.

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References

  1. Moe GK, Preston JB, Burlington H. Physiologic evidence for dual A-V transmission system. Circ Res. 1956;4:357–75.

    Article  CAS  Google Scholar 

  2. Wu D, Denes P, Dhingra R, Khan A, Rosen KM. The effects of propranolol on induction of AV nodal reentrant paroxysmal tachycardia. Circulation. 1974;50:665–77.

    Article  CAS  Google Scholar 

  3. Ben Yedder N, Roux JF, Ayala Paredes F. Troponin elevation in supraventricular tachycardia: primary dependence on heart rate. Can J Cardiol. 2011;27:105–9.

    Article  CAS  Google Scholar 

  4. Lim SH, Anantharaman V, Teo WS, Goh PP, Tan AT. Comparison of treatment of supraventricular tachycardia by Valsalva manoeuvre and carotid sinus massage. Ann Emerg Med. 1998;31:30–5.

    Article  Google Scholar 

  5. Walker S, Cutting P. Impact of a modified Valsalva manoeuvre in the termination of paroxysmal supraventricular tachycardia. Emerg Med J. 2010;27:287–91.

    Article  CAS  Google Scholar 

  6. DiMarco JP, Sellers TD, Berne RM, West GA, Belardinelli L. Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation. 1983;68:1254–63.

    Article  CAS  Google Scholar 

  7. Pritchett LC, Anderson RR, Benditt DG, Kasell J, Harrison L, Wallace AG, Sealy WC, Gallagher JJ. Reentry within the atrioventricular node: surgical cure with preservation of atrioventricular conduction. Circulation. 1979;60:440–6.

    Article  CAS  Google Scholar 

  8. Ross DL, Johnson DC, Denniss AR, Cooper MJ, Richards DA, Uther JB. Curative surgery for atrioventricular junctional (“AV nodal”) reentrant tachycardia. J Am Coll Cardiol. 1985;6:1383–92.

    Article  CAS  Google Scholar 

  9. Cox JL, Holman WL, Cain ME. Cryosurgical treatment of atrioventricular node reentrant tachycardia. Circulation. 1987;76:1329–36.

    Article  CAS  Google Scholar 

  10. Scheinman M, Morady F, Hess DS, Gonzalez R. Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA. 1982;248:851–5.

    Article  CAS  Google Scholar 

  11. Gallagher JJ, Svenson RH, Kasell JH, et al. Catheter technique for closed-chest ablation of the atrioventricular conduction system: a therapeutic alternative for the treatment of refractory supraventricular tachycardia. N Engl J Med. 1982;306:194–200.

    Article  CAS  Google Scholar 

  12. Haissaguerre M, Warin JF, Lemetayer P, Saoudi N, Guillem JP, Blanchot P. Closed-chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N Engl J Med. 1989;320:426–33.

    Article  CAS  Google Scholar 

  13. Epstein L, Scheinman M, Langberg J, Chilson D, Goldberg HR, Griffin JC. Percutaneous catheter modification of the atrioventricular node. Circulation. 1989;80:757–68.

    Article  CAS  Google Scholar 

  14. Goy JJ, Fromer M, Schlaepfer J, et al. Clinical efficacy of radiofrequency current in the treatment of patients with atrioventricular node reentrant tachycardia. J Am Coll Cardiol. 1990;6:418–23.

    Article  Google Scholar 

  15. Lee MA, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM, Griffin JC, Lesh MD, Pederson D, Goldberfer J, Calkins H, deBuitleir M, Kou WH, Rosenheck S, Sousa J, Langberg JJ. Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation. 1991;83:827–35.

    Article  CAS  Google Scholar 

  16. Haissaguerre M, Gaita F, Fischer B, Commenges D, Montserrat P, d’Ivernois C, Le Metayer P, Warin JF. Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation. 1992;85:2162–75.

    Article  CAS  Google Scholar 

  17. Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, Moulton KP, Twidale N, Hazlitt A, Prior MI, Oren J, Overholt ED, Lazzara R. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992;327:313–8.

    Article  CAS  Google Scholar 

  18. Jazayeri MR, Hempe SL, Sra JS, Hempe SL, Dhala AA, Blanck Z, Deshpande SS, Avitall B, Krum DP, Gilbert CI, Akhtar M. Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal re-entrant tachycardia. Circulation. 1992;85:1318–28.

    Article  CAS  Google Scholar 

  19. Akhtar M, Jazayeri MR, Sra J, Blanck Z, Desphande S, Dhala A. Atrioventricular nodal re-entry: clinical, electrophysiological, and therapeutic considerations. Circulation. 1993;88:282–95.

    Article  CAS  Google Scholar 

  20. Friedman PL, Dubuc M, Green MS, Jackman WM, Keane DT, Marinchak RA, Nazari J, Packer DL, Skanes A, Steiberg JS, Stevenson WG, Tchou PJ, Wilber DJ, Worley SJ. Catheter cryoablation of supraventricular tachycardia: results of the multicenter prospective “frosty” trial. Heart Rhythm. 2004;1:129–38.

    Article  Google Scholar 

  21. Rivard L, Dubuc GP, Novak P, Roy D, Macle L, Thibault B, Talajic M, Khairy P. Cryoablation outcomes for AV nodal re-entrant tachycardia comparing 4-mm versus 6-mm electrode-tip catheters. Heart Rhythm. 2008;5(2):230–4.

    Article  Google Scholar 

  22. Knight BP, Ebinger M, Oral H, Kim MH, Sticherling C, Pelosi F, Michaud GF, Strickberger SA, Morady F. Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia. J Am Coll Cardiol. 2000;36:574–82.

    Article  CAS  Google Scholar 

  23. Alvarez M, Tercedor L, Almansa I, Ros N, Galdeano RS, Burillo F, Santiago P, Penas R. Safety and feasibility of catheter ablation of atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance. Heart Rhythm. 2009;6(12):1714–20.

    Article  Google Scholar 

  24. Chaumont J, Al Baridi E, Roux J-F, Badra M, Arseneau F, Ayala-Paredes F. His area is closer than expected to RF ablation lesions in AVNR Tachycardia. Abstract 612. CCS Congress. October 30, 2012. Toronto. Canada. Can J Cardiol. 2012;28(5):S327.

    Article  Google Scholar 

  25. Kurian T, Abney LE, Gonogunta A, et al. Ablation of latest site(s) of activation within voltages bridges, voltage transition zones, and adjacent low voltage areas in the triangle of Koch to guide ablation for AVNRT. HRS May 11, 2018. Boston USA. Heart Rhythm. 2018;(5 Suppl) B-PO05-065 S515.

    Google Scholar 

  26. Wells P, Dubuc M, Klein GJ, Dan D, Roux JF, et al. Intracardiac ablation for atrioventricular nodal re-entry tachycardia using a 6 mm distal electrode cryoablation catheter: prospective, multicenter, North American study (ICY-AVNRT). J Cardiovasc Electrophysiol. 2018;29(1):167–76.

    Article  Google Scholar 

  27. Álvarez M, Bertomeu-González V, Arcocha MF, Moriña P, Tercedor L, Ferrero de Loma Á, Pachón M, García A, Pardo M, Datino T, Alonso C, Osca J, Investigators of the Spanish Multicenter Registry of Fluoroscopy-free Ablation. Nonfluoroscopic catheter ablation. Results from a prospective multicenter registry. Rev Esp Cardiol. 2017;70:699–705.

    Article  Google Scholar 

  28. Pani A, Giuseppina B, Bonanno C, Bongiorni MG, et al. Predictors of zero X-ray ablation for supraventricular tachycardias in a nationwide multicenter experience. Circ Arrhythm Electrophysiol. 2018;11(3):e005529.

    Article  Google Scholar 

  29. Casella M, Dello Russo A, Pelargonio G, et al. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multi-center randomized trial. Europace. 2016;18:1565–72.

    Article  Google Scholar 

  30. Raziminia M, Willoughby MC, Demo H, et al. Fluoroless catheter ablation of cardiac arrhythmias: a 5-year experience. Pacing Clin Electrophysiol. 2017;40(4):425–33.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Cardiology Service, Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain

    Miguel Alvarez Lopez

  2. Department of Cardiology, Arrhythmia Unit, Hospital Universitari Dr. Josep Trueta, Girona, Spain

    María Emilce Trucco

  3. Division of Cardiology, Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Canada

    Félix Ayala-Paredes

Authors
  1. Miguel Alvarez Lopez
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  2. María Emilce Trucco
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  3. Félix Ayala-Paredes
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Corresponding author

Correspondence to Félix Ayala-Paredes .

Editor information

Editors and Affiliations

  1. Department of Cardiac, Thoracic Vascular Sciences and Public Health, The University of Padua, Padua, Italy

    Riccardo Proietti

  2. Huazhong University of Science and Technology Tongji Hospital, Tongji Medical College, Wuhan, China

    Yan Wang

  3. Peking Union Medical College Hospital, National Center for Cardiovascular Disease, Beijing, China

    Yan Yao

  4. The First Affiliated Hospital of Guangxi Medical University , Nanning, China

    Guo Qiang Zhong

  5. Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China

    Shu Lin Wu

  6. Université de Sherbrooke , Sherbrooke, QC, Canada

    Félix Ayala-Paredes

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Lopez, M.A., Trucco, M.E., Ayala-Paredes, F. (2019). AV Nodal Reentrant Tachycardia Ablation Without Fluoroscopy. In: Proietti, R., Wang, Y., Yao, Y., Zhong, G., Lin Wu, S., Ayala-Paredes, F. (eds) Cardiac Electrophysiology Without Fluoroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-16992-3_7

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  • DOI: https://doi.org/10.1007/978-3-030-16992-3_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16991-6

  • Online ISBN: 978-3-030-16992-3

  • eBook Packages: MedicineMedicine (R0)

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