Atrioventricular Block During Catheter Ablation for Ventricular Arrhythmias

Tomofumi Nakamura; Ryohsuke Narui; Qi Zheng; Hirad Yarmohammadi; Usha B Tedrow; Bruce A Koplan; Gregory F Michaud; William G Stevenson; Roy M John

doi:10.1016/j.jacep.2018.10.005

Atrioventricular Block During Catheter Ablation for Ventricular Arrhythmias

JACC Clin Electrophysiol. 2019 Jan;5(1):104-112. doi: 10.1016/j.jacep.2018.10.005. Epub 2018 Nov 5.

Authors

Tomofumi Nakamura¹, Ryohsuke Narui², Qi Zheng³, Hirad Yarmohammadi³, Usha B Tedrow³, Bruce A Koplan³, Gregory F Michaud², William G Stevenson², Roy M John⁴

Affiliations

¹ Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
² Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
³ Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
⁴ Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: roy.john@vanderbilt.edu.

PMID: 30678774
DOI: 10.1016/j.jacep.2018.10.005

Abstract

Objectives: This study sought to evaluate the incidence and significance of atrioventricular (AV) block associated with ventricular arrhythmia (VA) ablation.

Background: Attempted ablation of VAs that arise from the septum carries a risk of AV block.

Methods: Data from 1,418 patients who had catheter ablation for drug-refractory VAs were evaluated. Two analyses were conducted. The first analysis assessed the patient and procedure characteristics associated with ablation-induced AV block. The second analysis investigated outcome differences between patients with and without AV block. For the second analysis, patients with AV block (Group I) were compared with a 1:2 propensity score-matched control group (Group II) and with patients with pre-existing AV block before ablation (Group III).

Results: Twenty-one (1.6%) patients developed AV block. In multivariable analysis, nonischemic cardiomyopathy (odds ratio: 3.33; 95% confidence interval: 1.32 to 8.40; p = 0.011) and transcoronary ethanol ablation (odds ratio: 46.50; 95% confidence interval: 14.10 to 153.00; p < 0.001) were independently associated with AV block. Subsequent to the AV block, 9 patients were upgraded from an implantable cardioverter-defibrillator to cardiac resynchronization therapy with defibrillator (CRT-D), 2 had de novo CRT-D implantation, 5 had pre-existing CRT-D, and 5 had pacing without CRT. VAs recurred in 33% of patients in Group I, 17% in Group II (log-rank p = 0.842), and 35% in Group III (p = 0.636). The composite outcome of heart failure hospitalization, heart transplantation, or death occurred in 29% of patients in Group I, 17% in Group II (p = 0.723), and 45% in Group III (p = 0.303).

Conclusions: Complete AV block occurs in fewer than 2% of patients undergoing VA ablation and does not appear to be associated with the worse outcome of heart failure hospitalization, heart transplantation, or death.

Keywords: atrioventricular block; catheter ablation; ventricular arrhythmia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arrhythmias, Cardiac* / physiopathology
Arrhythmias, Cardiac* / surgery
Atrioventricular Block* / etiology
Atrioventricular Block* / physiopathology
Catheter Ablation* / adverse effects
Catheter Ablation* / methods
Defibrillators, Implantable
Female
Heart Failure
Humans
Male
Middle Aged
Retrospective Studies