Abstract 14730: Does Slow Pathway Ablation Alone "Cure" Atrial Fibrillation in Patients with Coexistent AVNRT and Paroxysmal Atrial Fibrillation? Long Term Results from a Multicenter Study

Introduction: Previous studies showed that in patients with atrio-ventricular nodal re-entrant tachycardia (AVNRT) and paroxysmal AF (PAF), slow pathway ablation alone could eliminate both arrhythmias. We compared the long-term outcome of slow pathway ablation with or without concomitant pulmonary vein isolation (PVI) in patients with AVNRT and PAF. Methods: 46 patients with documented AVNRT triggering AF and symptomatic for regular and irregular palpitations were included in the study and divided into 2 groups. Group 1 (n=23) underwent slow pathway ablation alone using the standard technique while Group 2 consisted of 23 pts whose baseline characteristics were matched with Group 1 and underwent PVI plus slow pathway ablation. After ablation no AAD was given in both groups. Patients were followed-up by ECG, trans-telephonic recording, 7-day Holter and office visit. Results: In both groups AVNRT became non-inducible in all subjects; in Group 2 PVs isolation was achieved in all patients. No major complications were noted. After a mean follow-up of 7 years (94±18 months), no patients experienced AVNRT recurrence in both groups. However, when comparing freedom from AF, Group 2 had a statistically significant lower number of AF recurrence when compared to Group 1 (p<0.001, figure). Multivariate analysis including age, gender, structural heart disease, LA size, LVEF and ablation strategy indicated that the ablation strategy used in Group 2 was the only predictor to patient’s outcome (OR=2.7; p=0.02). Conclusions: At the long term follow-up, slow pathway ablation alone has limited effect on AF recurrence. Whether PVI should be performed in all patients with AVNRT and PAF to increase the long-term freedom from AF requires further investigation. ![Graphic][1] [1]: /embed/inline-graphic-1.gif