The Safety and Effectiveness of Slow Pathway Region Visualization Strategy in Radiofrequency Ablation for Adults With Atrioventricular Nodal Reentry Tachycardia: A Multicenter Retrospective Study

Abstract

Targeting the atrioventricular nodal slow pathway (AVNsp) is the standard treatment in catheter ablation procedures for atrioventricular nodal reentrant tachycardia (AVNRT). However, significant anatomical variability in Koch's triangle poses challenges for precise ablation and increases the risk of atrioventricular block (AVB). Previous studies have reported that the AVNsp visualization strategy reduces the incidence of AVB, however, these studies were conducted in pediatric patients or with the energy of cryoablation. However, the safety and effectiveness of this strategy in adults undergoing radiofrequency ablation (RFA) remains unclear. This study aimed to evaluate the safety and effectiveness of high-density mapping (HDM)-guided AVNsp visualization strategy for AVNRT ablation compared to the conventional approach. We retrospectively analyzed data from 149 AVNRT patients across 3 hospitals in China. Patients were divided into 2 groups: experimental group (i.e. treated with the HDM-guided AVNsp visualization strategy, n = 88) and control group (i.e. treated with the traditional mapping and ablation strategy, n = 61). Procedural parameters, complication rates, and long-term outcomes were compared. The experimental group required fewer ablation points (4.8 ± 3.6 vs 8.5 ± 7.7, p = 0.003), shorter total ablation time (284 ± 178 s vs 408 ± 345 s, p = 0.028), and reduced procedure time (41.4 ± 14.2 min vs 51.5 ± 27.2 min, p = 0.009) compared with the control group. No cases of AVB occurred in the experimental group, while the control group reported 5 (8.2%) transient AVB and 1 (1.6%) persistent first-degree AVB after procedure. After a mean follow-up of 488 ± 246 days, no recurrences of AVNRT were observed in either group. In conclusion, for adult patients with AVNRT, the AVNsp visualization strategy enhances the safety and effectiveness of RFA by reducing procedure time and minimizing the risk of AVB.