0040: Score for arrhythmias detection in symptomatic patients after AV node re-entrant tachycardia ablation

Abstract

Slow pathway radiofrequency ablation is used to treat atrioventricular nodal re-entrant tachycardia (AVNRT), but some patients remain symptomatic. The aim of study was to find predictive clinical factors of arrhythmias recurrence in symptomatic patients after AVNRT ablation and risk factors of AF occurrence. Slow pathway ablation was performed in 929 patients with AVNRT and aged 52±18 years. RF energy, 65°, 40 watts was delivered, until AVNRT was not induced. 94 patients were excluded because ablation failed. During follow-up (mean 2.2±2 years), 136 (16%) had recurrence of symptoms. After invasive and non-invasive studies, symptoms were related to a sinus tachycardia (n=39) (5%)(group I), a tachycardia of other origin (atrial fibrillation (AF) (n=54)(6%) (group II) or AVNRT recurrence (n=43) (5%) (group III); 699 patients were asymptomatic (84%) (group IV). Group II was older (60±12 years) than group III (51±20), I (33±15.5), IV (52±18)(p<0.001), less frequently female (48%) than group I (85%), III (63%), IV (66%)(p<0.001) and had more frequently history of AF (30%) than group I (3%), III (0%) and IV (3%). Other factors as induction after isoproterenol, mechanism of AVNRT, history of syncope, number of RF applications, were not different at univariate and multivariate analysis. A score ≥3 based on age and history of AF (1 for age 45-60 years, 2 for age >60, 3 for history of AF) identified all symptomatic patients with AF. A score 0 excluded patients with AF-related symptoms. Patients with only sinus tachycardia and recurrent AVNRT can not be differentiated except by a younger age, in case of sinus tachycardia. Recurrence of symptoms after successful AVNRT ablation is relatively frequent (16%), but recurrence of AVNRT is only present in 5% of patients. A score ≥3 based on age and history of AF identified all patients at risk of AF. Careful management is required in these patients.