3 years ago

Emergence of atrioventricular nodal reentry tachycardia after surgical or catheter ablation for atrial fibrillation: Are we creating the arrhythmia substrate?

Atrioventricular nodal reentry tachycardia (AVNRT) is common in adults and often involves reentry through ≥2 atrioventricular nodal-atrial connections. Although AVNRT can be a trigger for atrial fibrillation (AF), we have observed new-onset AVNRT after AF ablation procedures. Objective The purpose of this study was to determine whether ablation involving the septum or proximal coronary sinus (CS) during AF ablation may create a substrate favorable for AVNRT. Methods Cases of ablation for persistent AF who required a repeat ablation procedure between 2009 and 2016 were reviewed for diagnosis of AVNRT. Results Nine patients were identified; the mean age was 54 years, 7 (78%) were men, 2 with prior Cox-MAZE procedures, 5 had radiofrequency ablation (RFA) for AF, and 2 patients had both RFA and Cox-MAZE procedure. None of the patients with prior RFA had dual atrioventricular node physiology at baseline. All patients had evidence of atrial fibrosis in the septum or proximal CS, and 6 had undergone ablation either at the septum or the CS ostium/body, and the other 3 had received inferior mitral lines at a surgical MAZE procedure. All had typical AVNRT inducible that was abolished by slow pathway ablation, but 5 required ablation in the roof of the CS or on the mitral valve annulus. Conclusion Ablation involving the septum or proximal CS may create a substrate favorable for AVNRT. These findings are consistent with the theory that the posteroseptal left atrium and its connections to the CS are critical for some forms of AVNRT.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117309633

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