A comparative study of a modified catheter-mediated direct current and radiofrequency ablation on atrioventricular junction.

Abstract

Conventional His-bundle ablation, performed at the site with the largest His-bundle potential, displays a high incidence of a new right bundle branch block with loss of pacemaker escape. Damage to the perinodal atrial area may decrease the injury to the His-bundle, such that the escape pacemaker activity with a narrow QRS complex is produced. This study reports data from 25 patients with drug-refractory atrial tachyarrhythmias. Nine patients (group I) received radiofrequency (RF) ablation of the atrioventricular junction (AVJ). General anesthesia was not necessary in group I patients. During a mean follow-up period of 10 months, a complete AV block persisted in 5 patients, and a first degree AV block persisted in 2 patients; these patients were asymptomatic and did not require treatment with antiarrhythmic agents. A successful direct-current (DC) ablation was performed in one of the patients with an unsuccessful RF lesion, producing a new right bundle branch block (RBBB). Sixteen patients (group II) received DC ablation of the AVJ. During a mean follow-up period of 20 months, a complete AV block persisted in 9 patients, a first degree AV block was produced in 7 patients, and a new RBBB occurred in 2 patients. Fifteen patients (94%) were asymptomatic without administration of antiarrhythmic agents. Complications, including nonsustained ventricular tachycardia (1 patient) and pericarditis (1 patient), occurred immediately after ablation in group II. Myocardial injury, reflected by creatine kinase-MB isoenzyme, was higher in group II than in group I (25 +/- 2 vs 10 +/- 1 IU/l). We conclude that (1) catheter-mediated RF ablation of the AV junction is safer than DC ablation, (2) a majority of patients with drug-refractory atrial tachyarrhythmias can be successfully treated with RF ablation and (3) failure to achieve AV junction ablation with RF does not mitigate against successful application of DC ablation.