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CLINICAL STUDY: ELECTROPHYSIOLOGY

Is electrical stimulation during administration of catecholamines required for the evaluation of success after ablation of atrioventricular node re-entrant tachycardias?

Peter Weismüller, MD^*,*, Simone Kuly, MD, Bodo Brandts, MD^*, Klaus Kattenbeck, MD^*, Carsten Ranke, MD^* and Hans J. Trappe, MD^*

^* Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Herne, Germany
Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany

Manuscript received June 11, 2001; revised manuscript received October 26, 2001, accepted November 28, 2001.

^* Reprint requests and correspondence: Dr. Peter Weismüller, Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany.
Peter.Weismueller{at}ruhr-uni-bochum.de

OBJECTIVES: The purpose of this study was to answer the question of whether stimulation after administration of catecholamines is mandatory for identifying unsuccessful ablations of atrioventricular node re-entrant tachycardia (AVNRT).

BACKGROUND: The success of radiofrequency (RF) catheter ablation in AVNRT is confirmed in many centers by noninducibility of tachycardias during stimulation after the administration of catecholamines.

METHODS: A total of 131 patients (81 women and 50 men; mean age 53.6 ± 13.7 years [range 20 to 77]) were studied. Electrical stimulation was performed without and with the beta-adrenergic amine Orciprenaline (metaproterenol) before and after RF catheter ablation.

RESULTS: In 100 patients (76.3%; confidence interval [CI] 68.1% to 83.3%) an AVNRT was inducible without administration of Orciprenaline. Thirty minutes after the initially successful ablation in 95 patients, tachycardia was inducible in none of these patients, not even after Orciprenaline administration. In the 31 patients (23.7%; CI 16.7% to 31.9%) in whom there was no tachycardia inducible before ablation, Orciprenaline was given, and the stimulation protocol was repeated. In only five patients (3.8%; CI 1.3% to 8.7%) was there still no tachycardia inducible. After an initially successful ablation in the 26 patients who had inducible tachycardias with Orciprenaline before ablation, no tachycardia could be re-induced. After Orciprenaline, the tachycardia was inducible again in only one patient.

CONCLUSIONS: Only patients who require catecholamines for tachycardia induction before ablation need catecholamines for control of the success of the ablation of AVNRT.

Abbreviations and Acronyms   AVNRT   AH   A2-H2 interval   AV   atrioventricular   AVNRT   atrioventricular node re-entrant tachycardia   CI   confidence interval   ECG   electrocardiogram or electrocardiographic   RF   radiofrequency

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