Potential-guided versus anatomic-guided approach for slow pathway ablation of the common type atrioventricular nodal reentry tachycardia: a randomized study

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 anatomic-guided 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 follow-up, 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.