|
The atrio-ventricular nodal reentrant tachycardia
radiofrequency ablation is a safe, consolidated procedure with a success-rate close to
100%, and very few recurrences during the follow-up. Comparable results are obtained using
both anatomic1,2 and electrophysiologic3-5 approach.
In our experience (up to 150 treated patients), the electrophysiological marker for
the successful ablation site has been the recording of the Haissaguerre slow potential3 or the sharp Jackman potential5
as marker of slow pathway.
The aim of the study is to evaluate reliability, advantages and costs of the
radiofrequency catheter ablation procedure (RF) of atrio-ventricular nodal reentrant
tachycardia with slow pathway approach, using besides the ablation catheter, a diagnostic
transesophageal catheter for atrial stimulation and recording.
We usualy utilize the transesophageal electrophysiologic study in the management of
the supraventricular tachycardias6,7 and to evaluate
the risk in patients with Wolff-Parkinson-White8,9.
Unlike endocavitary catheters, the transesophageal ones can be reused many times after
sterilization since they do not come in contact with blood.
For the procedure to be effective we must induce atrio-ventricular nodal reentrant
tachycardia before the procedure and verify the non-inducibility of the tachycardia with
atrial pacing after10. To perform this task only a
catheter able to pace and record atrial potential is needed. The same catheter is also
used to assest the retroconduction of the junctional beats evocated by successful RF
delivery (Fig. 1). The transesophageal catheter is able to satisfy these requirements.
 
Fig. 1: Accelerated junctional rhythm recorded during RF delivery in successful slow
pathway ablation. The development of an accelerated junctional rhythm during application
of radiofrequency current is typical of successful slow pathway ablation.
|
