Impact of induced atrial fibrillation during atrioventricular nodal reentrant tachycardia ablation

Abstract

Abstract Ablation is the treatment of choice for atrioventricular nodal reentrant tachycardia (AV NRT). Atrial fibrillation (AF) can incidentally occur during this procedure, labeling these patients (P) as susceptible for AF in the future. Our aim was to assess the presence of new onset AF in P who presented this arrhythmia during the electrophysiological study (EPS). Methods We retrospectively analyzed 580 P that underwent AV NRT ablation between November 2008 and August 2020. Patients with previous AF were excluded. After having AF induced during the EPS, 62 P were identified as susceptible for developing AF. Data were collected by contacting P and consulting medical records. Results The studied population had 64.5% (n=40) females, 35.5% (n=22) males, with ages between 15 and 81years old (median 52.3, mean 50.1). At ablation date, 33.9% (n=21) had hypertension, 3.2% (n=2) diabetes, 6.5% (n=4) chronic kidney disease, 3.2% (n=2) obstructive sleep apnea, 6.5% (n=4) coronary artery disease and 6.5% (n=4) structural heart disease. Previously to ablation, 46.8% (n=29) were on beta-blocker, 1.6% (n=1) on amiodarone and 3.2% (n=2) on flecainide. When admitted to the procedure, 98.4% (n=61) were in sinus rhythm and 1.6% (n=1) had a pacemaker. "Slow-fast" was the most common AVNRT type (96.8%). During the EPS, other arrhythmias were induced: in 12.9% (n=8) atrial flutter and in 9.7% (n=6) atrial tachycardia. After AF induction, 12.9% (n=8) needed electrical cardioversion and 3.2% (n=2) needed both electrical and pharmacological. At the time of ablation, transient complete atrioventricular block was noted in 6.5% (n=4) P. When contacted, 100% (n=62) had 1 year of follow-up, 69.4% (n=43) 5 years and 25.8% (n=16) 10 years, with a mean follow-up of 6.6 years. It was not possible to contact 12.9% (n=8) of the P, of those, 6.5% (n=4) died and 6.5% (n=4) did not reply. Recurrence of AV NRT was documented in 6.4% (n=4) P and all underwent a successful second ablation. Almost one third, 32.3% (n=20), were symptomatic, mainly with palpitations, and 27.4% (n=17) maintained follow up with a Cardiologist. New-onset AF was documented in 1 P only (1.6%), diagnosed 9 years after the procedure. Conclusion In our cohort, the induction of AF during EPS did not translate into clinical AF during follow-up. Whether this is a nonspecific finding related to catheter manipulation or pacing maneuvers on pharmacological provocation deserves further investigation.