Ten Year Follow-Up After Radiofrequency Catheter Ablation for Atrioventricular Nodal Reentrant Tachycardia in the Early Days Forever Cured, or a Source for New Arrhythmias?

• Published in: Pacing and clinical electrophysiology 2005-12, Vol.28 (12), p.1302-1309
• Main Authors: KIMMAN, G.P., BOGAARD, M.D., VAN HEMEL, N.M., VAN DESSEL, P.F.H.M., JESSURUN, E.R., BOERSMA, L.V.A., WEVER, E.F.D., THEUNS, D.A.M.J., JORDAENS, L.J.
• Format: Article
• Language: English
• Subjects: Adult; Arrhythmias, Cardiac - epidemiology; atrioventricular nodal reentrant tachycardia; Catheter Ablation; Chi-Square Distribution; Female; Follow-Up Studies; Heart Conduction System - physiopathology; Humans; long-term follow-up; Male; Middle Aged; proarrhythmia; radiofrequency; Recurrence; Surveys and Questionnaires; Tachycardia, Atrioventricular Nodal Reentry - physiopathology; Tachycardia, Atrioventricular Nodal Reentry - surgery
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2005.00271.x

Background: Radiofrequency (RF) catheter ablation is highly effective with a low complication rate. However, lesions created by RF energy are irreversible, inhomogeneous, and therefore potentially proarrhythmic. Objectives: The aim of this study was to examine the magnitude and importance of long‐term proarrhythmic effects of RF energy. Methods and Results: Between 1991 and 1995, 120 patients underwent RF ablation for atrioventricular nodal reentrant tachycardia (AVNRT). Patient data were collected by contacting patients and/or filling out a questionnaire, and medical files were screened for recurrent, documented arrhythmias, pharmacological treatment, and repeated EP study. Referring cardiologists were asked about recurrences of tachyarrhythmias. Fourteen patients (11%) were lost to follow‐up. During a mean follow‐up of 10 years, six patients died. Recurrences of AVNRT were not any more observed after 3 years after ablation. A total of 29 patients (24%) suffered from new arrhythmias, 6 from type 1 atrial flutter, 6 from atrial tachycardia, 9 from atrial fibrillation, and finally 16 from symptomatic premature atrial contractions (PACs), needing medical treatment or a combination of these arrhythmias. Nine patients underwent pacemaker implantation, 4 after developing procedural atrioventricular (AV) conduction disturbances, 2 after His ablation for permanent atrial fibrillation, 1 patient for sick sinus syndrome, and another 2 patients after developing late AV block, respectively, 7 and 9 years after ablation. Conclusion: During long‐term follow‐up after RF ablation for AVNRT, no AVNRT recurrences were observed, but 29 patients (24%) suffered from new arrhythmias or late AV block. This potential proarrhythmic effect of RF energy promotes the application of alternative energy sources for ablative therapies for cardiac arrhythmias.