ReviewTransient proarrhythmic state following atrioventricular junction radiofrequency ablation: pathophysiologic mechanisms and recommendations for management☆
Section snippets
Materials and methods
English-language clinical studies and case reports on AV junction or His ablation since 1982 were identified from MEDLINE via PubMed. Key references (published articles) rather than key words were used, and the reference lists created by the PubMed tool “Related articles” were reviewed. A personal database of relevant articles was also used.
In addition, we included our single-center experience involving 259 consecutive patients who underwent successful AV junction radiofrequency ablation from
Results
The English-language literature included five case reports on 7 patients 16, 17, 18, 19, 20. In addition, four cohort studies of 32 to more than 300 patients included 16 other patients with early life-threatening ventricular arrhythmias following AV junction radiofrequency ablation 13, 21, 22, 23, of whom at least 3 died (Table).
In addition, clinically important ventricular arrhythmias presumably related to the procedure were observed in 3 of our 259 patients. There were no deaths during the 30
Discussion
The induction of complete AV block by ablation of the AV junction using direct-current shock delivered through endocardially placed catheters was described in 1982 24, 25. In a subsequent report of 91 patients who underwent this treatment, 7 patients (8%; 95% CI: 3% to 15%) had ventricular arrhythmias up to 30 days after ablation, of whom 2 had a sustained ventricular arrhythmia (26). In another study of 136 patients, 8 died during hospitalization, of whom 6 (4%; 95% CI: 2% to 9%) suffered from
Acknowledgements
The authors are grateful to Marian Lettosunti for technical assistance.
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This study was supported by grants from Karolinska Institutet, and the Swedish Heart-Lung Foundation for which Dr. Bergfeldt is a clinical investigator.