| Background and ObjectivesAtrioventricular nodal reentrant tachycardia(AVNRT) is the most widespread group of arrhythmias in adults. A wide variety of drugs can be used to control episodes of AVNRT. Long-term drug therapy is associated with frequent recurrences and adverse effects, however. There are 3 leaps in the development of Radiofrequency catheter ablation ( RFCA) to treat AVNRT: Slow pathway modification therapy has proved so effective that it is clearly the first choice for patients with the total efficient rate as high as 98.8% andfew complications. However, complications due to the procedure are still inevitable and one of the most serious is III° atrioventricular block(AVB) which is about 0.4-0.8%. Such patients are forced to implant permanent pacemaker which leads to heavy burden to both patients and doctors. To prevent III° AVB has become an increasingly urgent problem and a lot of studies have been done. Energy discharge approach for the RFCA is one of the most efficient way to decrease III° AVB and has been widely used However, there are few reports on neither quantity analysis on the total energy output during the RFCA process nor its relation with the ratio of effective ablation targets /total ablation targets. As for the correlation between energy output and its complication such as above I°AVB and recurrence, it has not been reported. So, we retrospective analysis of 865 cases of AVNRT have been treated with radiofrequency ablation. By analyze the total energy output , ablation targets and recurrence rate, we try to find some significant ways to decrease the complications.Study methodsRetrospective analysis of 865 cases of AVNRT treated with radiofrequency ablation. Stop using anti-arrhythmic drugs for above 5 half lives. Examine blood, urine and stool routine, live and renal function, electrolyte, preoperative immune items , chest X ray, ECGand heart Ultrasound, etc. Patients with other complications should be treated and reevaluated to make sure whether he can tolerate the procedure.Based on Seldinger procedure, we put 6F four-poles catheter to HRA, RV and HIS bund and 10-poles catheter to coronary sinus through left subclavian vein. Multi-channel recorder was used to record the surface electrocardiograms and cardiac electrophysiological graphs. The electrophysiological study ( EPS ) examination was finished and the electrophysiological indexes for slow pathway ablation procedure were evaluated. RF electrical pole catheter was put in through femoral vein, the targeted points for ablation were detected around tricuspid valve and then ablation was started. Energy discharge approach was used during the whole ablation process, which started from power 10 W, increased step by step, till the ablation was finished. Then repeat the EPS procedure. SPSS11.5 was used. All data were described by (?)± s and analyzed by t or X~2 test. P < 0.05 was statistical significance.Study results1) The success rate of RFC A treatment is 99.42% and recurrence rate 2.08%. There are 10 cases experienced complications and no severe complications.2) For targeted points (?) 5.0 group, patients whose ratio ofeffective targeted points/total targeted points(%) <70 and the total energy output(W*S) ≥2300 are more likely to develop above I° AVB complication and the difference was statistical significant. However, there was no remarkable difference for recurrent rate.3) For effective targeted points/total targeted points(%) >70 patients, the total energy output(W*S) arrived to 2300 more easyly , the difference was statistical significant to the group of effective targeted points/total targeted points(%) <704) There are positive correlation between effective targeted points/total targeted points(%) < 70 group and total energy output(W*S) >2300 group and patients under such conditions have close relation to the above I° AVB complication. Targeted points (?) 5.0 also closely linked to the increased above I° AVB complication, but has no direct relation to the effective targeted points/total targeted points(%) < 70,which need further studies.ConclusionRFCA to treat AVNRT is safe and effective and above I° AVB complication is increased with the increased total energy output. By chosing efficient targeted points, decreasing discharged points and times, and controlling total energy output, we are supposed to decrease and prevent the above I° AVB complication.
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