Arrhythmias & electrophysiology
Unexpected transient atrioventricular block and slow junctional rhythm using pulsed field ablation for slow pathway modification: Excited or cautious for ablators
Authors' conclusion
Despite the high efficiency of PFA for SPM, the notable incidence of transient AVB warranted caution when applying it near the His bundle. SJR frequently occurred during SPM and was dependent on moderate CF.
Study context
- Population
- Patients with typical atrioventricular nodal reentrant tachycardia (AVNRT) undergoing slow pathway modification with a focal pulsed field ablation (PFA) catheter (biphasic/bipolar)
- Participants
- 40 patients
- Outcome
- Efficacy and safety of PFA
- Follow-up
- during the procedure and at 6-month follow-up
Main finding
As reported in the abstract
Acute success of slow pathway modification
all 40 patients
Sinus rhythm maintained without significant adverse events at 6-month follow-up
All patients
Total ablation time (mean ± SD)
7.9 ± 3.8 seconds
Ablation sites (mean ± SD)
6.4 ± 2.2
Observational data: associations, not effects.
Further findings
Slow junctional rhythm (SJR) during ablation
- SJR induced
- 32 (80%)
- SJR duration
- 28.9 ± 10.3 seconds
- Ablation sites with SJR per patient
- 3.0 ± 1.1
- SJR reinduced at 9 ablation sites after contact force increase from 1.3 ± 0.5g to 6.4 ± 1.3 g
- P < 0.0001
Slow pathway distance from largest His activation
- Distance
- 11.1 ± 1.2 mm
Safety
Transient atrioventricular block (AVB) · during procedure
- Transient AVB (1 second-degree, 6 third-degree)
- 7 (17.5%)
- Duration of transient AVB, seconds
- 435.3 ± 227.4
- AS-LHA distance, AVB vs no AVB (mm)
- 7.7 ± 0.6 vs 11.3 ± 1; P < .0001
- Preceded by PFA-related delayed atrial-His (n = 6) and His-atrial (n = 1) conduction, constant His-ventricular interval
- Normal PR interval restored within 24 h
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Summarised from the published abstract; every number is checked against it