Long‐Term Follow‐up of Atrioventricular Junctional Transcatheter Electrical Ablation

Publisher Website
Google Scholar
Abstract
Complete data concerning long-term results of transcatheter electrical ablation of the atrioventricular junction is not available. At the request of the French Cardiac Arrhythmia Working group we undertook an inquiry in October 1983. All centers potentially able to perform such procedures were asked to report their experience. Eight centers have performed one case or more, over a period of 3 years, for a total of 91 patients. The mean follow-up completed in all patients in April 1986 was 12 ± 10 months. The procedure was indicated for a supraventicular arrhythmia resistant to a mean of 3.9 ± 1.3 classes of antiarrhythmic agents. Atrial flutter or fibrillation in 54 (59%) and atrioventricular nodal reentry in 17 (18%J were the most common arrhythmias. A mean of 2.6 ± 2.3 electrical shocks (range 1–14 shocks) with a stored energy of 130–400 joules was delivered during 1–5 sessions. Complete heart block was obtained in 83 patients and persisted at the time of discharge from the hospital in 46 patients (50.5%). The immediate complication (within 24 hours after the procedure) included ventricular fibrillation successfully converted (one patient) and nonsustained ventricular tachycardia (three patients). Late complications included one death 3 days after the procedure, in a patient in whom sustained ventricular tachycardia was documented, nonsustained ventricular tachycardia in two patients, sepsis in three patients and pericardial effusion in one patient. At the time of the follow-up, there were three additional deaths related to sepsis due to pacemaker pocket infection in one patient and to preexisting congestive heart failure in two patients. Chronic complete heart block was present in 36 patients (41%) high degree heart block (2 nd degree or advanced) in seven patients (8%) first degree in 16 patients (18%). The remaining patients had either normal PR interval or were in atrial fibrillation. Seventy-five patients (82%) were asymptomatic including 39 patients with resumption of AV conduction with (28 patients, 30%) or without (11 patients, 12%) antiarrhythmic therapy. The procedure failed in 12 patients (13%). This experience suggests that AV junctional transcatheter ablation is a highly effective procedure. However, the potential of early and late complications including arrhythmic death leads us to reserve this technique to patients with drug-refractory supraventricular tachyarrhythmias and in whom other forms of therapy are not applicable.