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Title: Potential-guided versus anatomic-guided approach for slow pathway ablation of the common type atrioventricular nodal reentry tachycardia: a randomized study
Author(s): M. Efremidis , A. Sideris , K. P. Letsas , I.P. Alexanian , L.K. Pappas , C.C. Mihas , D. Manolatos , S. Xydonas , G. Gavrielatos , G. S. Filippatos , F. Kardaras
Journal: Acta Cardiologica
Volume: 64    Issue: 4   Date: 2009   
Pages: 477-483
DOI: 10.2143/AC.64.4.2041612

Abstract :
Objective — The present study aimed to compare the effectiveness and safety of the potential- and the anatomic-guided approach for slow pathway ablation in patients with recurrent episodes of symptomatic common type atrioventricular (AV) nodal reentrant tachycardia.
Methods — Two hundred and twenty-eight patients were randomly assigned to undergo either a potential- (n = 114, 47% men, mean age 52.85 ± 14.04 years) or an anatomic-guided approach (n = 114, 50% men, mean age 52.45 ± 14.46 years) for radiofrequency ablation of the slow pathway. The mean duration of the follow-up period was 26.7 ± 7.9 and 24.8 ± 7.6 months in the potential- and anatomicguided approach, respectively (P > 0.05).
Results — The success rate for slow pathway ablation was 100% in both ablative methods. The mean duration of atrial electrograms at the successful ablation sites of the potential- and the anatomic-guided approaches was 69 ± 14 msec and 57 ± 10 msec, respectively (P = 0.001). There were no significant differences between the potential- and the anatomic-guided approach regarding the duration of the procedure (121.13 ± 56.83 vs. 109.93 ± 57.12 min, P = 0.139), the duration of fluoroscopic exposure (6.12 ± 3.32 vs. 6.64 ± 3.33 min, P = 0.239) or the mean number of radiofrequency applications delivered (3.96 ± 2.77 vs. 4.33 ± 2.73, P = 0.311). Residual dual AV nodal pathway following successful ablation was observed in 9.6% of patients who underwent the potential-guided approach and in 23.7% of patients who underwent the anatomic method (P = 0.004). During followup, arrhythmia recurrence was observed in four patients (1.8%), two in each group (P > 0.05).
Conclusions — The efficacy and safety of the slow pathway ablation is very high using either the potential- or the anatomic-guided approach.

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