การเปรียบเทียบอัตราการเกิดซํ้าที่หนึ่งปีของภาวะหัวใจเต้นเร็วจากการหมุนเวียนไฟฟ้าภายในต่อมอะตริโอเวนตริคูลาร์หลังการรักษาด้วยคลื่นวิทยุความถี่สูง: การศึกษาเปรียบเทียบระหว่างกลุ่มที่ไม่เหลือและเหลือเส้นทางการนำไฟฟ้าช้าบางส่วนที่ต่อมอะตริโอเวนตริคูลาร์ในโรงพยาบาลอุตรดิตถ์

Kan Chairat

Authors

Kan Chairat Internal medicine department, Uttaradit hospital

Keywords:

AVNRT, slow pathway, RFCA, recurrence

Abstract

Objective: To compare the recurrence rate of AVNRT 1-year period between patients who underwent RFCA treatment until the slow pathway was completely eliminated and patients who still have a residual slow pathway but cannot provoke AVNRT.
Methods: The study is a retrospective cohort study of AVNRT patients who were received RFCA treatment between January 1, 2016 and January 1, 2024 with follow-up for 1 year after RFCA. The recurrence rate of AVNRT was compared between the group with a residual slow pathway and the group with no slow pathway remaining.
Results: The patients diagnosed with AVNRT who underwent EP study and RFCA at Uttaradit Hospital between January 1, 2016 and January 1, 2024 the RFCA success rate was 93.9%. The overall complication rate for RFCA in AVNRT patients was 0.6%, with one case of transient AV block. The 1-year recurrence rate after RFCA in AVNRT patients who underwent treatment with no remaining slow pathway was compared to those with a residual slow pathway but unable to provoke AVNRT. The recurrence rates were not significantly different statistically, with a recurrence rate of 1% in the group with no remaining slow pathway and 6.5% in the group with a residual slow pathway, yielding adjusted hazard ratio of 7.8 (95% CI 0.76-79.83), p=0.083.
Conclusions: The 1-year recurrence rate after RFCA in AVNRT patients who underwent treatment with no remaining slow pathway was compared to those with a residual slow pathway but unable to provoke AVNRT, and there was no statistically significant difference.

References

Orejarena LA, Vidaillet H Jr, DeStefano F, Nordstrom DL, Vierkant RA, Smith PN, et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol. 1998;31:150-7.

Porter MJ, Morton JB, Denman R, Lin AC, Tierney S, Santucci PA, et al. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm. 2004;1:393–6.

Mani BC, Pavri BB. Dual atrioventricular nodal pathways physiology: a review of relevant anatomy, electrophysiology, and electrocardiographic manifestations. Indian Pacing Electrophysiol J. 2014;14(1):12-25.

Wood KA, Drew BJ, Scheinman MM. Frequency of disabling symptoms in supraventricular tachycardia. Am J Cardiol. 1997;79(2):145-9.

Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. Eur Heart J. 2019;00:1-65.

Page RL, Abraham WT, Casey MA, Chung MK, Dickfeld BH, Flegel SA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart

Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016 Apr 5;133(14):e471-505.

Issa ZF, Miller JM, Zipes DP, editors. Clinical arrhythmology and electrophysiology: A companion to Braunwald’s heart disease. 3rd ed. Philadelphia: Elsevier; 2019. p.560-98.

Reddy CD, Silka MJ, Bar-Cohen Y. A comparison of AV nodal reentrant tachycardia in young children and adolescents: electrophysiology, ablation, and outcomes. Pacing Clin Electrophysiol. 2015;38:1325-32.

Backhoff D, Klehs S, Muller MJ, Kostelka M, Ensslen R, Dähnert I, et al. Long-term follow-up after catheter ablation of atrioventricular nodal reentrant tachycardia in children. Circ Arrhythm Electrophysiol. 2016 Nov;9(11):e004264.

Bogun F, Knight B, Weiss R, Bahu M, Souza J, Pelosi F, et al. Slow pathway ablation in patients with documented but noninducible paroxysmal supraventricular tachycardia. J Am Coll Cardiol. 1996 Oct;28(4):1000-4.

Chrispin J, Misra S, Marine JE, Calkins H, Spragg DD. Current management and clinical outcome for catheter ablation of atrioventricular nodal re-entrant tachycardia. Europace. 2018;20:e15-59.

ฮันตระกูล ก. การศึกษาลักษณะและอัตราการเกิดซํ้าของผู้ป่วยภาวะหัวใจเต้นเร็วจากการหมุนเวียนไฟฟ้าภายในต่อมอะตริโอเวนตริคูลาร์ ภายหลังการรักษาด้วยวิธีจี้ด้วยคลื่นความถี่วิทยุ [วิทยานิพนธ์]. กรุงเทพมหานคร: จุฬาลงกรณ์มหาวิทยาลัย, คณะแพทยศาสตร์; 2019. doi:10.58837/CHULA.THE.2019.1474.