Caijie Shen, Rong Bai, Zhenyu Jia, Mingjun Feng, Yibo Yu, Xianfeng Du, Guohua Fu, Tao Wu, Yongxing Jiang, He Jin, Lipu Yu, Renyuan Fang, Weidong Zhuo, Jiating Dai, Fang Gao, Binhao Wang, Si Chen, Xinhui Qiu, Tingsha Du, Xinzhi Yu, Chenxu Luo, Yiqi Lu, Feifan Ouyang, Huimin Chu
{"title":"使用脉冲场消融术改变慢速通路时出现意外的一过性房室传导阻滞和缓慢交界性心律：消融者是兴奋还是谨慎？","authors":"Caijie Shen, Rong Bai, Zhenyu Jia, Mingjun Feng, Yibo Yu, Xianfeng Du, Guohua Fu, Tao Wu, Yongxing Jiang, He Jin, Lipu Yu, Renyuan Fang, Weidong Zhuo, Jiating Dai, Fang Gao, Binhao Wang, Si Chen, Xinhui Qiu, Tingsha Du, Xinzhi Yu, Chenxu Luo, Yiqi Lu, Feifan Ouyang, Huimin Chu","doi":"10.1016/j.hrthm.2024.09.023","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Data regarding the effects of pulsed field ablation (PFA) on atrioventricular nodal reentrant tachycardia (AVNRT) are limited.</p><p><strong>Objective: </strong>To evaluate the outcomes of PFA for AVNRT, and its impact on dual-pathway electrophysiology.</p><p><strong>Methods: </strong>A larger cohort of patients with typical AVNRT underwent slow pathway (SP) modification (SPM) using a focal PFA catheter in a biphasic/bipolar manner. The primary endpoints were the efficacy and safety of PFA during the procedure and 6-month follow-up.</p><p><strong>Results: </strong>The acute success of SPM was achieved in all 40 patients. The total ablation time was 7.9±3.8 seconds for 6.4±2.2 ablation sites (ASs). Slow junctional rhythm (SJR) was induced in 32 (80%) patients lasting 28.9±10.3 seconds in 3.0±1.1 ASs per patient. SP was located 11.1±1.2 mm from the largest His activation (LHA). At 9 ASs, SJR could be reinduced after an increase of contact force (CF) from 1.3±0.5g to 6.4±1.3g (P<0.0001). Transient atrioventricular block (AVB) was recorded in 7(17.5%) patients (1 second-degree and 6 third-degree AVB) lasting 435.3±227.4 seconds, with a shorter AS-LHA distance than patients without AVB (7.7±0.6 mm vs. 11.3±1 mm, P<0.0001). PFA-related delayed atrial-His (n=6) and His-atrial (n=1) conduction preceded transient AVB with a constant His-ventricular interval. Normal PR interval was restored within 24 hours. All patients maintained sinus rhythm without any significant adverse events during 6-month follow-up.</p><p><strong>Conclusion: </strong>Despite the high efficiency of PFA for SPM, the notable incidence of transient AVB warranted caution when applying it near the His bundle. SJR frequently occurred during SPM and was dependent on moderate CF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unexpected transient atrioventricular block and slow junctional rhythm using pulsed field ablation for slow pathway modification: excited or cautious for ablators.\",\"authors\":\"Caijie Shen, Rong Bai, Zhenyu Jia, Mingjun Feng, Yibo Yu, Xianfeng Du, Guohua Fu, Tao Wu, Yongxing Jiang, He Jin, Lipu Yu, Renyuan Fang, Weidong Zhuo, Jiating Dai, Fang Gao, Binhao Wang, Si Chen, Xinhui Qiu, Tingsha Du, Xinzhi Yu, Chenxu Luo, Yiqi Lu, Feifan Ouyang, Huimin Chu\",\"doi\":\"10.1016/j.hrthm.2024.09.023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Data regarding the effects of pulsed field ablation (PFA) on atrioventricular nodal reentrant tachycardia (AVNRT) are limited.</p><p><strong>Objective: </strong>To evaluate the outcomes of PFA for AVNRT, and its impact on dual-pathway electrophysiology.</p><p><strong>Methods: </strong>A larger cohort of patients with typical AVNRT underwent slow pathway (SP) modification (SPM) using a focal PFA catheter in a biphasic/bipolar manner. The primary endpoints were the efficacy and safety of PFA during the procedure and 6-month follow-up.</p><p><strong>Results: </strong>The acute success of SPM was achieved in all 40 patients. The total ablation time was 7.9±3.8 seconds for 6.4±2.2 ablation sites (ASs). Slow junctional rhythm (SJR) was induced in 32 (80%) patients lasting 28.9±10.3 seconds in 3.0±1.1 ASs per patient. SP was located 11.1±1.2 mm from the largest His activation (LHA). At 9 ASs, SJR could be reinduced after an increase of contact force (CF) from 1.3±0.5g to 6.4±1.3g (P<0.0001). Transient atrioventricular block (AVB) was recorded in 7(17.5%) patients (1 second-degree and 6 third-degree AVB) lasting 435.3±227.4 seconds, with a shorter AS-LHA distance than patients without AVB (7.7±0.6 mm vs. 11.3±1 mm, P<0.0001). PFA-related delayed atrial-His (n=6) and His-atrial (n=1) conduction preceded transient AVB with a constant His-ventricular interval. Normal PR interval was restored within 24 hours. All patients maintained sinus rhythm without any significant adverse events during 6-month follow-up.</p><p><strong>Conclusion: </strong>Despite the high efficiency of PFA for SPM, the notable incidence of transient AVB warranted caution when applying it near the His bundle. SJR frequently occurred during SPM and was dependent on moderate CF.</p>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2024-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hrthm.2024.09.023\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2024.09.023","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Unexpected transient atrioventricular block and slow junctional rhythm using pulsed field ablation for slow pathway modification: excited or cautious for ablators.
Background: Data regarding the effects of pulsed field ablation (PFA) on atrioventricular nodal reentrant tachycardia (AVNRT) are limited.
Objective: To evaluate the outcomes of PFA for AVNRT, and its impact on dual-pathway electrophysiology.
Methods: A larger cohort of patients with typical AVNRT underwent slow pathway (SP) modification (SPM) using a focal PFA catheter in a biphasic/bipolar manner. The primary endpoints were the efficacy and safety of PFA during the procedure and 6-month follow-up.
Results: The acute success of SPM was achieved in all 40 patients. The total ablation time was 7.9±3.8 seconds for 6.4±2.2 ablation sites (ASs). Slow junctional rhythm (SJR) was induced in 32 (80%) patients lasting 28.9±10.3 seconds in 3.0±1.1 ASs per patient. SP was located 11.1±1.2 mm from the largest His activation (LHA). At 9 ASs, SJR could be reinduced after an increase of contact force (CF) from 1.3±0.5g to 6.4±1.3g (P<0.0001). Transient atrioventricular block (AVB) was recorded in 7(17.5%) patients (1 second-degree and 6 third-degree AVB) lasting 435.3±227.4 seconds, with a shorter AS-LHA distance than patients without AVB (7.7±0.6 mm vs. 11.3±1 mm, P<0.0001). PFA-related delayed atrial-His (n=6) and His-atrial (n=1) conduction preceded transient AVB with a constant His-ventricular interval. Normal PR interval was restored within 24 hours. All patients maintained sinus rhythm without any significant adverse events during 6-month follow-up.
Conclusion: Despite the high efficiency of PFA for SPM, the notable incidence of transient AVB warranted caution when applying it near the His bundle. SJR frequently occurred during SPM and was dependent on moderate CF.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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