Feasibility Of A “Single-Catheter,No-X-ray Approach” For Ablation Of Atrioventricular Nodal Reentrant Tachycardia

Objective(s):To investigate the methodology,feasibility,safety and effectiveness of a “singlecatheter,no-X-ray approach”for ablation of atrioventricular nodal reentrant tachycardia induced by dual pathway.Methods:A total of 44 patients diagnosed with AVNRT by esophageal electrophysiological examination in The First Affiliated Hospital of Kunming Medical University from December 2020 to August 2022 were enrolled.They were randomly divided into two groups,21 patients undergoing single catheter radiofrequency catheter ablation were enrolled as the study group,and 23 patients undergoing traditional ablation were enrolled as the control group.Baseline data such as age,gender,past medical history,clinical symptoms and signs,medication,cardiac ultrasound and electrocardiogram were collected before ablation.All patients agreed and signed informed consent for this study.In the traditional ablation group,at least 3 venous approaches should be established before ablation,along which the decapolar catheter was placed into the coronary sinus and the quadripolar catheter was placed into the right ventricle for electrophysiology study,and the ablation catheter was placed for ablationafter diagnosis.In the single catheter ablation group,only puncture the right femoral vein once,place an ablation catheter through the arterial sheath,and complete cardiac electrophysiology sdudy and radiofrequency catheter ablation.Preoperative sinus rhythm electrocardiogram,AVNRT electrocardiogram,intraoperative electrophysiology study and radiofrequency catheter ablation endocardiogram were collected from the two groups.The operation time was recorded from the beginning of puncture to the end point of ablation.The cost of collecting the vascular sheath,diagnostic catheter and ablation catheter generated by the operation shall be the cost of the operation.The duration and dose of intraoperative X-ray exposure were recorded.Postoperative follow-up was conducted for puncture complications,atrioventricular block,pericardial tamponade and other serious complications,and recurrence.Results:Both groups completed electrophysiology study and slow pathway ablation of AVNRT,with an immediate success rate of 100%.Compared with the control group,the radiofrequency catheter ablation time was not statistically significant [8.30±4.00(min)vs.9.46±4.26(min),p > 0.05],and the total operation time was significantly reduced [56.90±23.40(min)vs.85.9±24.23(min),p< 0.001].The ablation cost was significantly reduced [2.05(2.02,2.06)(ten thousand yuan)vs.2.57(2.55,2.63)(ten thousand yuan),p < 0.001].The average fluoroscopy time of the control group was5.38±3.83(min),and the average radiation exposure was 88.39±77.52(m Gy).Compared with the control group,the study group did not use X-ray in the whole process,achieving zero radiation ablation therapy.Puncture complications,atrioventricular block and pericardial tamponade were not found in both groups.Postoperative follow-up of the two groups of patients showed that there were 2patients in the control group and 1 patient in the study group with different degrees of postoperative palpitation discomfort,and no evidence of atrioventricular nodal dual pathway was found by esophageal electrophysiological examination,and no tachycardia was induced,and no evidence of recurrence.Conclusion(s):The“single-catheter,no-X-ray approach”for ablation of atrioventricular nodal reentrant tachycardia is feasible,safe,effective and economical.