Unexpected transient atrioventricular block and slow junctional rhythm using pulsed field ablation for slow pathway modification: Excited or cautious for ablators

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-07-01 DOI:10.1016/j.hrthm.2024.09.023

Caijie Shen MD, PhD , Rong Bai MD, FHRS , Zhenyu Jia MM , Mingjun Feng MD , Yibo Yu MD , Xianfeng Du MD , Guohua Fu MD , Tao Wu MD , Yongxing Jiang MD, PhD , He Jin MD , Lipu Yu MD , Renyuan Fang MD , Weidong Zhuo MD , Jiating Dai , Fang Gao MD , Binhao Wang MD , Si Chen MD , Xinhui Qiu MM , Tingsha Du MM , Xinzhi Yu MM , Huimin Chu MD

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Abstract

Background

Data regarding the effects of pulsed field ablation (PFA) on atrioventricular nodal reentrant tachycardia (AVNRT) are limited.

Objective

This study was undertaken to evaluate the outcomes of PFA for AVNRT and its impact on dual-pathway electrophysiology.

Methods

A larger cohort of patients with typical AVNRT underwent slow pathway (SP) modification (SPM) using a focal PFA catheter in a biphasic/bipolar manner. The primary endpoints were the efficacy and safety of PFA during the procedure and at 6-month follow-up.

Results

The acute success of SPM was achieved in all 40 patients. The total ablation time was 7.9 ± 3.8 seconds for 6.4 ± 2.2 ablation sites (ASs). Slow junctional rhythm (SJR) was induced in 32 (80%) patients, lasting 28.9 ± 10.3 seconds in 3.0 ± 1.1 ASs per patient. SP was located 11.1 ± 1.2 mm from the largest His activation (LHA). At 9 ASs, SJR could be reinduced after an increase of contact force (CF) from 1.3 ± 0.5g to 6.4 ± 1.3 g (P < .0001). Transient atrioventricular block (AVB) was recorded in 7 (17.5%) patients (1 second-degree and 6 third-degree AVB) lasting 435.3 ± 227.4 seconds, with a shorter AS-LHA distance than patients without AVB (7.7 ± 0.6 mm vs. 11.3 ± 1 mm; P < .0001). PFA-related delayed atrial-His (n = 6) and His-atrial (n = 1) conduction preceded transient AVB with a constant His-ventricular interval. Normal PR interval was restored within 24 hours. All patients maintained sinus rhythm without any significant adverse events during 6-month follow-up.

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.

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使用脉冲场消融术改变慢速通路时出现意外的一过性房室传导阻滞和缓慢交界性心律：消融者是兴奋还是谨慎？

背景：有关脉冲场消融术（PFA）对房室结性返流性心动过速（AVNRT）影响的数据有限：评估脉冲场消融术治疗房室结再发性心动过速的效果及其对双通道电生理学的影响：方法：使用双相/双极方式的病灶 PFA 导管，对一大批典型房室缺血性心动过速患者进行慢通路 (SP) 改造 (SPM)。主要终点是手术期间和 6 个月随访期间 PFA 的有效性和安全性：结果：所有40名患者都取得了SPM的急性成功。总消融时间为 7.9±3.8 秒，消融位点（AS）为 6.4±2.2。32 名患者（80%）在每个患者 3.0±1.1 个 AS 中诱导出慢交界节律（SJR），持续时间为 28.9±10.3 秒。SP 位于距最大 His 激活点 (LHA) 11.1±1.2 mm 处。在 9 个 AS 中，接触力（CF）从 1.3±0.5g 增加到 6.4±1.3g（PC 结论：尽管 PFA 对 SJR 有很高的疗效，但它并不能使 SJR 恢复正常：尽管 PFA 用于 SPM 的效率很高，但在 His 束附近使用时，一过性房室传导阻滞的显著发生率值得警惕。在 SPM 期间经常出现 SJR，并且依赖于适度的 CF。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.