THE "POSTEROSEPTAL ROVE" FOR ABLATION OF AV JUNCTIONAL REENTRANT TACHYCARDIA: COMPARISON WITH THE ELECTROGRAM GUIDED APPROACH
D. Whalley* and K. Hellestrand.
Royal North Shore and Sydney Adventist Hospitals, Sydney, New South Wales.
We compared the efficacy, safety and time-efficiency of a continuous posteroseptal catheter roving technique (PSR) targeting the induction of sustained junctional rhythm, with the conventional electrogram-guided approach (EGA) utilising "slow pathway potentials" for cure of AVJRT. The end-point of both techniques was non-inducibility of AVJRT during infusion of isoprenaline +/- atropine.
Results: (Mean ± SD). The study population comprised a total of 378 patients. Both the PSR and EGA groups were well matched for age, sex distribution, tachycardia cycle length and duration of symptoms.
|
ABLATION TECHNIQUE |
PRIMARY SUCCESS |
SCREENING TIME (min) |
PROCEDURE TIME (min) |
No. LESIONS |
|
EGA, n = 181 |
97.2% |
22.5±12.5 |
119.0±49.9 |
7.8±4.7 |
|
PSR, n = 197 |
98.9% |
13.1±10.2 |
82.5±22.9 |
3.5±3.0 |
|
P value |
NS |
<0.001 |
<0.001 |
<0.001 |
Recurrence of symptomatic AVJRT occurred in 3.3% of EGA patients at a mean follow-up of 36.2±11.7 mths, and 3.0% of PSR patients at follow-up of 14.8±6.8 mths (NS). Transient 3º AV block occurred in 2.2% of patients undergoing EGA and 2.0% of those undergoing PSR (NS). One patient in the EGA group developed persistent 3º AV block, requiring permanent pacemaker implantation.
We conclude that in comparison to the EGA technique, the PSR is efficacious, safe, minimises radiation exposure to the operator and patient and decreases total procedure time.
