How to Approach Difficult Cases of AVNRT

Research output: Contribution to journalReview article

Abstract

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.

Original languageEnglish (US)
Article number34
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume19
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Reciprocating Tachycardia
Cryosurgery
Catheters
Coronary Sinus
Septum of Brain
Patent Foramen Ovale
Supraventricular Tachycardia
Heart Atria
Punctures
Tachycardia

Keywords

  • AVNRT
  • Cryoablation
  • Radiofrequency catheter ablation
  • Slow pathway

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

How to Approach Difficult Cases of AVNRT. / Kumar, Darpan S.; Dewland, Thomas; Balaji, Seshadri; Henrikson, Charles.

In: Current Treatment Options in Cardiovascular Medicine, Vol. 19, No. 5, 34, 01.05.2017.

Research output: Contribution to journalReview article

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