DECENNIAL ANALYSIS OF AVNRT ABLATION IN A SINGLE CENTRE

Abstract

Abstract Background Transcatheter ablation represents the first line therapy for atrio–ventricular nodal re–entrant tachycardia (AVNRT). Both radiofrequency (RF) and cryoablation (CRYO) have been shown to be effective, with a better safety profile for CRYO. Data on very long–term efficacy are scarces. Purpose To review our experience in AVNRT ablation performed in the last ten years and evaluate safety, efficacy and very long–term outcome of RF and CRYO. Methods We retrospectively analyzed all patients who underwent AVNRT ablation (RF or CRYO) between January 2013 and May 2023 at our centre. The majority of procedures were performed under electro–anatomical mapping (EAM) guidance to reduce radiation exposure. Acute efficacy endpoint was defined as slow pathway ablation, while long–term outcome was defined as the absence of AVNRT recurrence. Results A total of 387 consecutive patients (60,5% F; mean age 48 ± 19 years) were included; CRYO was performed in 241 patients (62%), RF in 131 patients (34%), hybrid approach (CRYO+RF) in 15 patients (4%). AVNRT induction was obtained during EPS in 295 cases (76%), in 25,4% after isoprotenerol administration. No significant differences for baseline characteristics were observed between the two groups except for age (CRYO: 42,2 ± 18 years vs RF 57,19 ± 16,5 years p <0.001). In pediatric population CRYO was performed in 93% of procedures. Figure 1 shows the distribution of RF/CRYO over 10 years at our centre, with a trend of significant increase in CRYO utilizations in the last years. Acute success was achieved in all 387 cases (100%; delta WP 28,5 ± 23,1 ms, delta AVN ERP 72,4 ± 44,7 ms). No permanent AV block or major periprocedural complications occurred, however transient AH prolongation was observed in 0.8% in CRYO pts vs 2,8% RF pts. The mean follow–up was 73±45 months, range 6–129 months. Overall long–term success rate was 93,3%, ranging from 91,3 % in CRYO and 96,6% in RF. Recurrence occurred in 26 cases (6,7%) after a median time of 20 months (4–40months). Recurrent AVNRT were treated with RF in the majority of cases, CRYO in 6 procedures, hybrid in only 1 case. Conclusions Transcatheter ablation is a safe and effective therapy for AVNRT. Our very long–term outcome data confirmed very high success rate even after 10 years follow–up. The increasing choice for CRYO may be due to the increasing number of pediatric and young patient referred to our centre.