Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study

TY - JOUR

T1 - Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study

AU - Hartmann, Jens

AU - Jungen, Christiane

AU - Stec, Sebastian

AU - Klatt, Niklas

AU - Willems, Stephan

AU - Makimoto, Hisaki

AU - Steven, Daniel

AU - Pürerfellner, Helmut

AU - Martinek, Martin

AU - Meyer, Christian

PY - 2020/8

Y1 - 2020/8

N2 - BACKGROUND: Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node.METHODS AND RESULTS: In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months).CONCLUSION: This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.

AB - BACKGROUND: Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node.METHODS AND RESULTS: In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months).CONCLUSION: This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.

KW - Atrioventricular Node/physiopathology

KW - Catheter Ablation/methods

KW - Electrocardiography

KW - Female

KW - Follow-Up Studies

KW - Heart Rate/physiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Tachycardia, Atrioventricular Nodal Reentry/diagnosis

KW - Treatment Outcome

U2 - 10.1007/s00392-020-01596-y

DO - 10.1007/s00392-020-01596-y

M3 - SCORING: Journal article

C2 - 32002633

VL - 109

SP - 1025

EP - 1034

JO - CLIN RES CARDIOL

JF - CLIN RES CARDIOL

SN - 1861-0684

IS - 8

ER -