AV nodal ablation: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 5: | Line 5: | ||
==Overview== | ==Overview== | ||
Atrioventricular nodal or AV junction ablation is a procedure by which the electrical pathways that connect the [[atria]] to the [[ventricles]] are modified or interrupted in order to restore a normal cardiac rhythm. This procedure creates a disconnect between the upper chambers (which controls the heart rate and rhythm) and the lower chambers (ventricles). Due to the invasive nature of the procedure and the requirement for a pacemaker implantation, AVNA is mostly as a fallback treatment in patients with [[atrial fibrillation]] that is refractory to medications, or have developed side effects to the medications. | Atrioventricular nodal or AV junction ablation is a procedure by which the electrical pathways that connect the [[atria]] to the [[ventricles]] are modified or interrupted in order to restore a normal cardiac rhythm. This procedure creates a disconnect between the upper chambers (which controls the heart rate and rhythm) and the lower chambers (ventricles). Due to the invasive nature of the procedure and the requirement for a pacemaker implantation, AVNA is mostly as a fallback treatment in patients with [[atrial fibrillation]] that is refractory to medications, or have developed side effects to the medications. It is important to note that this procedure is not a cure for the atrial fibrillation, its function is to regulate the ventricular rate. Therefore, patients will still require life-long anticoagulation. | ||
==Indications== | ==Indications== | ||
| Line 11: | Line 11: | ||
* Recurrent symptomatic [[atrial tachycardia]] in which all therapeutic options have failed | * Recurrent symptomatic [[atrial tachycardia]] in which all therapeutic options have failed | ||
==Procedure== | ==Procedure== | ||
===Process== | |||
During this procedure, a special catheter is passed through the femoral vein into the heart under [[Fluoroscopy|fluoroscopic guidance]]. Once the catheter is in place, a small amount of radiofrequency energy or heat is applied adjacent to the [[AV node]] in order to destroy it or create a scar which permanently blocks the entry of fast impulses from the atrium. After a successful ablation, the ventricles will no longer respond to the impulses from the atria, in other words, they beat independently of each other. The ventricular rate is about 40 beats per minute which may be too slow for adequate perfusion under exercise conditions, therefore, an implantation of a [[Artificial pacemaker|permanent pacemaker]] is required. | During this procedure, a special catheter is passed through the femoral vein into the heart under [[Fluoroscopy|fluoroscopic guidance]]. Once the catheter is in place, a small amount of radiofrequency energy or heat is applied adjacent to the [[AV node]] in order to destroy it or create a scar which permanently blocks the entry of fast impulses from the atrium. After a successful ablation, the ventricles will no longer respond to the impulses from the atria, in other words, they beat independently of each other. The ventricular rate is about 40 beats per minute which may be too slow for adequate perfusion under exercise conditions, therefore, an implantation of a [[Artificial pacemaker|permanent pacemaker]] is required. | ||
===Risks of The Procedure=== | |||
The procedure is relatively safe, but there are some risks associated with the procedure either during or after the procedure. They are: | |||
* [[Cardiac tamponade]] - This occurs in less than 1% of cases. The catheter electrode may perforate the heart causing a collection of blood around the heart. This may require the insertion of a drain to remove the blood. | |||
* Damage to the blood vessels - Occasionally, the blood vessels may be perforated by the catheter electrode. | |||
* [[Pneumothorax|Iatrogenic pneumothorax]] - The lung wall may be punctured resulting into leakage of air into the pleural space. This may require a drain in order to re-inflate the lungs. | |||
* Other risks include: [[hemorrhage]] at the operation site, [[hemothorax]], [[pulmonary embolism]], [[stroke]], but these are extremely rare. | |||
==Complications and Prognosis== | ==Complications and Prognosis== | ||
* Development of inappropriate sinus tachycardia.<ref name="Kocovic-1993">{{Cite journal | last1 = Kocovic | first1 = DZ. | last2 = Harada | first2 = T. | last3 = Shea | first3 = JB. | last4 = Soroff | first4 = D. | last5 = Friedman | first5 = PL. | title = Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. | journal = Circulation | volume = 88 | issue = 4 Pt 1 | pages = 1671-81 | month = Oct | year = 1993 | doi = | PMID = 8403312 }}</ref> RF ablation in the anterior, mid, and posterior regions of the low interatrial septum may disrupt preganglionic or postganglionic parasympathetic fibers located in these regions that are destined to innervate the sinus node. | * Development of inappropriate sinus tachycardia.<ref name="Kocovic-1993">{{Cite journal | last1 = Kocovic | first1 = DZ. | last2 = Harada | first2 = T. | last3 = Shea | first3 = JB. | last4 = Soroff | first4 = D. | last5 = Friedman | first5 = PL. | title = Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. | journal = Circulation | volume = 88 | issue = 4 Pt 1 | pages = 1671-81 | month = Oct | year = 1993 | doi = | PMID = 8403312 }}</ref> RF ablation in the anterior, mid, and posterior regions of the low interatrial septum may disrupt preganglionic or postganglionic parasympathetic fibers located in these regions that are destined to innervate the sinus node. | ||
* Ventricular fibrillation<ref name="Geelen-1997">{{Cite journal | last1 = Geelen | first1 = P. | last2 = Brugada | first2 = J. | last3 = Andries | first3 = E. | last4 = Brugada | first4 = P. | title = Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. | journal = Pacing Clin Electrophysiol | volume = 20 | issue = 2 Pt 1 | pages = 343-8 | month = Feb | year = 1997 | doi = | PMID = 9058872 }}</ref> | * Ventricular fibrillation<ref name="Geelen-1997">{{Cite journal | last1 = Geelen | first1 = P. | last2 = Brugada | first2 = J. | last3 = Andries | first3 = E. | last4 = Brugada | first4 = P. | title = Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. | journal = Pacing Clin Electrophysiol | volume = 20 | issue = 2 Pt 1 | pages = 343-8 | month = Feb | year = 1997 | doi = | PMID = 9058872 }}</ref> | ||
Revision as of 21:49, 5 September 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]
Synonyms and keywords: AVNA
Overview
Atrioventricular nodal or AV junction ablation is a procedure by which the electrical pathways that connect the atria to the ventricles are modified or interrupted in order to restore a normal cardiac rhythm. This procedure creates a disconnect between the upper chambers (which controls the heart rate and rhythm) and the lower chambers (ventricles). Due to the invasive nature of the procedure and the requirement for a pacemaker implantation, AVNA is mostly as a fallback treatment in patients with atrial fibrillation that is refractory to medications, or have developed side effects to the medications. It is important to note that this procedure is not a cure for the atrial fibrillation, its function is to regulate the ventricular rate. Therefore, patients will still require life-long anticoagulation.
Indications
- Control of ventricular rate in atrial fibrillation
- Recurrent symptomatic atrial tachycardia in which all therapeutic options have failed
Procedure
=Process
During this procedure, a special catheter is passed through the femoral vein into the heart under fluoroscopic guidance. Once the catheter is in place, a small amount of radiofrequency energy or heat is applied adjacent to the AV node in order to destroy it or create a scar which permanently blocks the entry of fast impulses from the atrium. After a successful ablation, the ventricles will no longer respond to the impulses from the atria, in other words, they beat independently of each other. The ventricular rate is about 40 beats per minute which may be too slow for adequate perfusion under exercise conditions, therefore, an implantation of a permanent pacemaker is required.
Risks of The Procedure
The procedure is relatively safe, but there are some risks associated with the procedure either during or after the procedure. They are:
- Cardiac tamponade - This occurs in less than 1% of cases. The catheter electrode may perforate the heart causing a collection of blood around the heart. This may require the insertion of a drain to remove the blood.
- Damage to the blood vessels - Occasionally, the blood vessels may be perforated by the catheter electrode.
- Iatrogenic pneumothorax - The lung wall may be punctured resulting into leakage of air into the pleural space. This may require a drain in order to re-inflate the lungs.
- Other risks include: hemorrhage at the operation site, hemothorax, pulmonary embolism, stroke, but these are extremely rare.
Complications and Prognosis
- Development of inappropriate sinus tachycardia.[1] RF ablation in the anterior, mid, and posterior regions of the low interatrial septum may disrupt preganglionic or postganglionic parasympathetic fibers located in these regions that are destined to innervate the sinus node.
- Ventricular fibrillation[2]
References
- ↑ Kocovic, DZ.; Harada, T.; Shea, JB.; Soroff, D.; Friedman, PL. (1993). "Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart". Circulation. 88 (4 Pt 1): 1671–81. PMID 8403312. Unknown parameter
|month=ignored (help) - ↑ Geelen, P.; Brugada, J.; Andries, E.; Brugada, P. (1997). "Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction". Pacing Clin Electrophysiol. 20 (2 Pt 1): 343–8. PMID 9058872. Unknown parameter
|month=ignored (help)