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A prospective evaluation of the impact of individual RF applications for slow pathway ablation for AVNRT: markers of acute success
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  • Hariharan Sugumar,
  • David Chieng,
  • Sandeep Prabhu,
  • Aleksandr Voskoboinik,
  • Robert Anderson,
  • Ahmed Al-Kaisey,
  • Geoffrey Lee,
  • Alex McLellan,
  • Joseph Morton,
  • Andrew Taylor,
  • Liang-Han Ling,
  • Jonathan Kalman,
  • Peter Kistler
Hariharan Sugumar
Alfred Hospital
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David Chieng
Baker Heart and Diabetes Institute
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Sandeep Prabhu
Alfred Hospital
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Aleksandr Voskoboinik
Alfred Health
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Robert Anderson
Royal Melbourne Hospital
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Ahmed Al-Kaisey
The Royal Melbourne Hospital
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Geoffrey Lee
The Royal Melbourne Hospital
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Alex McLellan
Royal Melbourne Hospital
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Joseph Morton
Royal Melbourne Hospital
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Andrew Taylor
Alfred Health
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Liang-Han Ling
Alfred Hospital
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Jonathan Kalman
Royal Melbourne hospital
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Peter Kistler
Alfred Hospital
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Abstract

Background: Catheter ablation is highly effective for AVNRT. Generally junctional rhythm(JR) is an accepted requirement for successful ablation however there is a lack of detailed prospective studies to determine the characteristics of JR and the impact on slow pathway conduction. Methods: Multicentre prospective observational study evaluating the impact of individual radiofrequency(RF) applications in typical AVNRT(Slow/Fast). Characteristics of JR during ablation were documented and detailed testing was performed after every RF application to determine outcome. Procedural success was defined as ≤1 AV nodal echo. Results: Sixty-seven patients were included(mean age 53±18years, 57% female and a history of SVT 2.9±4.7years). RF(50w,60degrees) ablation for AVNRT was applied in 301 locations with JR in 178(59%). Successful slow pathway modification was achieved in 66(99%) patients with slow pathway block in 30(46%). Success was associated with JR in all patients. Success was achieved in 6 patients with RF<10 seconds. There was no significant difference in the CL of JR during RF between effective(587±150ms) vs ineffective (611±193ms,p=0.4) applications. Inadvertent JA-block with immediate termination of RF was observed in 19(28%) patients with AVNRT no longer inducible in 14(74%). Freedom from SVT was achieved in 66(99%) patients at a mean follow up of 15±6 months. Conclusion: In this prospective study, JR was required during RF for acute success in AVNRT. Cycle length of JR during RF was not predictive of success. Unintended JA block during faster JR was associated with slow pathway block. RF applications as short as 10s resulting in junctional rhythm may be successful in some patients.

Peer review status:ACCEPTED

14 Oct 2020Submitted to Journal of Cardiovascular Electrophysiology
08 Dec 2020Submission Checks Completed
08 Dec 2020Assigned to Editor
09 Dec 2020Reviewer(s) Assigned
25 Dec 2020Review(s) Completed, Editorial Evaluation Pending
28 Dec 2020Editorial Decision: Revise Minor
21 Feb 20211st Revision Received
25 Feb 2021Submission Checks Completed
25 Feb 2021Assigned to Editor
25 Feb 2021Reviewer(s) Assigned
15 Mar 2021Review(s) Completed, Editorial Evaluation Pending
19 Mar 2021Editorial Decision: Accept