Department of Cardiology II - Electrophysiology, University Hospital Muenster.
Int Heart J. 2021 Jan 30;62(1):72-77. doi: 10.1536/ihj.20-463. Epub 2021 Jan 16.
Atrioventricular nodal reentry tachycardia (AVNRT) is the most common regular supraventricular tachycardia (SVT). Slow pathway modification (SPM) is the accepted first line treatment with reported success rates around 95%. Information regarding possible predictors of AVNRT recurrence is scarce.Out of 4170 consecutive patients with SPM in our department from 1993-2018, we identified 78 patients (1.9%) receiving > 1 SPM (69% female, median age 50 years) with a recurrence of AVNRT after a successful SPM. We matched these patients for age, gender and number of radiofrequency applications during first SPM with 78 patients who received one successful SPM in our center without AVNRT recurrence. Both groups were analyzed for possible predictors of a recurrence of AVNRT during long-term follow-up. The recurrence group contained a significantly lower proportion of patients with an occurrence of junctional beats during SPM (69% versus 89%, P = 0.006). Moreover, significantly more cases of previously diagnosed atrial fibrillation/tachycardia (AF/AT; 21% versus 5%, P = 0.007) and inducible AF/AT during electrophysiology study (23% versus 6%, P = 0.006) were present in the recurrence group. While more than half of patients had a recurrence within the first year, in 20% symptoms reappeared ≥ 4 years after ablation.In a small percentage of patients, AVNRT recurs after an initially successful ablation. Interestingly, these patients had significantly fewer junctional beats during ablation and a higher rate of other (inducible) arrhythmias. AVNRT recurrence spanned a considerable timeframe and should remain a differential diagnosis, even years after ablation.
房室结折返性心动过速（AVNRT）是最常见的规则性室上性心动过速（SVT）。慢径路改良（SPM）是公认的一线治疗方法，报道的成功率约为 95%。关于 AVNRT 复发的可能预测因素的信息很少。在我们部门 1993-2018 年间进行的 4170 例连续 SPM 中，我们确定了 78 例（1.9%）接受了 > 1 次 SPM（69%为女性，中位年龄为 50 岁），在成功 SPM 后 AVNRT 复发。我们将这些患者的年龄、性别和首次 SPM 期间的射频应用次数与在我们中心接受过一次成功 SPM 且无 AVNRT 复发的 78 例患者进行匹配。对两组患者进行了长期随访中 AVNRT 复发的可能预测因素分析。复发组中，在 SPM 期间出现交界性搏动的患者比例明显较低（69%比 89%，P = 0.006）。此外，复发组中先前诊断为心房颤动/心动过速（AF/AT；21%比 5%，P = 0.007）和电生理研究期间可诱发的 AF/AT 的情况明显更多（23%比 6%，P = 0.006）。虽然超过一半的患者在第一年复发，但有 20%的症状在消融后≥4 年再次出现。在一小部分患者中，AVNRT 在最初成功消融后复发。有趣的是，这些患者在消融期间交界性搏动明显减少，而其他（可诱发的）心律失常的发生率较高。AVNRT 复发的时间跨度相当长，即使在消融后数年，也应保持鉴别诊断。
