Atrioventricular Nodal Reentrant Tachycardia in Patients Referred for Atrial Fibrillation Ablation: Response to Ablation That Incorporates Slow-Pathway Modification
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Background— Although the most common sites of atrial ectopy that trigger atrial fibrillation (AF) are in or around the pulmonary veins (PVs), atrioventricular nodal reentrant tachycardia (AVNRT) can also cause or coexist with AF. We sought to characterize patients with AF and AVNRT and assess clinical outcomes after ablation. Methods and Results— To determine the prevalence of concomitant AVNRT and AF, 629 consecutive patients referred for catheter ablation between November 1998 and March 2005 were studied. Electrophysiological studies with programmed stimulation during isoproterenol infusion identified atrial ectopy that initiated AF and the presence of inducible AVNRT. AF ablation consisted of proximal isolation of PVs and elimination of any non-PV trigger of AF, including AVNRT. There were 27 patients (4.3%) who had inducible AVNRT at the time of AF ablation. Of these, 13 underwent AVNRT ablation without PV isolation. Compared with the rest of the cohort, patients with AVNRT and AF were younger at the time of symptom onset (age 36.8±13.8 versus 48.2±11.7 years; P <0.01). Freedom from AF with or without previously ineffective antiarrhythmic medication was similar in both groups (96.3% versus 90.7%; mean follow-up 21.4±9.4 months); however, patients with AVNRT targeted for ablation were more likely to be AF free while not taking any antiarrhythmic medication after a single procedure during the follow-up period (87.5% versus 54.7%; P <0.01) and had fewer complications (0% versus 2.5%; P =0.30). Twelve of the 13 patients who underwent slow-pathway ablation without left atrial ablation remained AF free without the need for antiarrhythmic medication after a single procedure. Conclusions— AVNRT is an uncommon AF trigger seen more frequently in younger patients. Ablation of AVNRT in patients with AF was associated with improved outcomes compared with those with other triggers of AF.
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AF may be triggered by other arrhythmias, for example, AVRT or AVNRT, especially in younger patients.
“Notably, AF may be triggered by other arrhythmias, for example, AVRT or AVNRT, especially in younger patients, and it is important to document this before selecting appropriate treatment (Calkins et al., 2012;Sauer et al., 2006).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Sauer et al., 2006
The Clinical Perspective and Conclusions say AVNRT can trigger AF, is seen more often in younger patients, and should be identified before choosing an ablation strategy. The Identification and Ablation of AF Triggers section mentions AVRT only as an arrhythmia to distinguish from AVNRT; it does not establish AVRT as an AF trigger. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAtrioventricular nodal reentrant tachycardia may result in atrial fibrillation, which is usually, though not invariably, eliminated after catheter ablation of AVNRT.
“Atrioventricular nodal reentrant tachycardia may result in AF that usually, although not invariably, is eliminated following catheter ablation of AVNRT.224”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [224]
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- Authors
- Sauer, W. H., Alonso, C., Zado, E., Cooper, J. M., Lin, D., Dixit, S., Russo, A., Verdino, R., Ji, S., Gerstenfeld, E. P., Callans, D. J., & Marchlinski, F. E.
- Affiliations
- University of Pennsylvania Health System (US)
- From the Electrophysiology Section, Cardiovascular Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pa. Dr Sauer is currently at the University of Colorado at Denver and Health Sciences Center, Denver, Colo.
- ORCID
- Venue
- Circulation
- Published
- 2006-07-18
- Volume
- 114
- Issue
- 3
- Pages
- 191-195
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2120427492
- Cited by
- 106
- References
- 13
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 10 · 2023: 4 · 2021: 4 · 2020: 5 · 2019: 7 · 2018: 4 · 2017: 17 · 2016: 3 · 2015: 7 · 2014: 5 · 2013: 1 · 2012: 8
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrioventricular nodal reentrant tachycardia, atrial fibrillation, atrial ectopy, catheter ablation, slow pathway ablation, pulmonary vein isolation, antiarrhythmic drugs, atrial fibrillation triggers, programmed electrical stimulation, isoproterenol
- MeSH terms
- Adult, Atrial Fibrillation, Atrioventricular Node, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pulmonary Veins, Regression Analysis, Tachycardia, Time Factors, Cohort Studies, Prevalence, Multivariate Analysis, Catheter Ablation
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