Inadvertent atrioventricular block during radiofrequency catheter ablation. Results of the Pediatric Radiofrequency Ablation Registry. Pediatric Electrophysiology Society.

Abstract

BACKGROUND: Inadvertent atrioventricular block is a complication of radiofrequency ablation. The present study is an analysis of the incidence, significance, and factors associated with inadvertent atrioventricular block during radiofrequency catheter ablation in childhood and adolescence. METHODS AND RESULTS: The records of the Pediatric Radiofrequency Ablation Registry were reviewed. Between January 1, 1991, and April 1, 1994, atrioventricular block occurred in 23 of 1964 radiofrequency ablations (1.2%): 14 as third-degree block (3 transient) and 9 as second-degree block (5 transient). Atrioventricular block occurred from 5 seconds to 2 months (mean, 4.1 days; median, 15 seconds) after the onset of the energy application. Eight transient cases lasted 1 hour to 1 month (mean, 9.4 days; median, 7 days). Inadvertent atrioventricular block was related to the ablation anatomic site: 3 of 111 (2.7%) anteroseptal, 11 of 106 (10.4%) midseptal, and 2 of 197 (1.0%) right posteroseptal sites (P = .0007) for anteroseptal, P = .0001 for midseptal, and P = .17 for right posteroseptal versus nonright septal sites). Five of 314 (1.6%) ablations for atrioventricular nodal reentrant tachycardia resulted in atrioventricular block (P = .004 versus nonright septal sites). Compared with a matched subgroup, radiofrequency ablation experience was the only significant risk factor (32.7 versus 106.6, P = .002) for the occurrence of atrioventricular block. CONCLUSIONS: Inadvertent atrioventricular block may occur during or late after radiofrequency catheter ablation. It is associated with ablations for (1) anterior and midseptal accessory pathways and atrioventricular nodal reentry and (2) relative institutional inexperience.

AI evidence extraction

Main findings

Among 1964 radiofrequency ablations, atrioventricular block occurred in 23 cases (1.2%): 14 third-degree (3 transient) and 9 second-degree (5 transient). Occurrence was associated with ablation site (higher rates at anteroseptal and especially midseptal sites) and with lower institutional ablation experience; AV block could occur during or up to 2 months after energy application.

Outcomes measured

• Inadvertent atrioventricular block (second-degree and third-degree; transient vs persistent)
• Timing of atrioventricular block after energy application
• Association of atrioventricular block with ablation anatomic site
• Association of atrioventricular block with institutional experience

Limitations

• Registry record review (observational design)
• Frequency/dosimetry parameters of radiofrequency energy not reported in abstract
• Potential for unmeasured confounding; matched subgroup details not provided in abstract

Suggested hubs

• occupational-exposure (0.15)
  Involves radiofrequency energy use in a clinical procedure; not an environmental/telecom exposure study.

{
    "study_type": "cohort",
    "exposure": {
        "band": null,
        "source": "radiofrequency catheter ablation",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": "Energy application; AV block occurred 5 seconds to 2 months after onset (mean 4.1 days; median 15 seconds)."
    },
    "population": "Childhood and adolescence patients undergoing radiofrequency catheter ablation (Pediatric Radiofrequency Ablation Registry)",
    "sample_size": 1964,
    "outcomes": [
        "Inadvertent atrioventricular block (second-degree and third-degree; transient vs persistent)",
        "Timing of atrioventricular block after energy application",
        "Association of atrioventricular block with ablation anatomic site",
        "Association of atrioventricular block with institutional experience"
    ],
    "main_findings": "Among 1964 radiofrequency ablations, atrioventricular block occurred in 23 cases (1.2%): 14 third-degree (3 transient) and 9 second-degree (5 transient). Occurrence was associated with ablation site (higher rates at anteroseptal and especially midseptal sites) and with lower institutional ablation experience; AV block could occur during or up to 2 months after energy application.",
    "effect_direction": "harm",
    "limitations": [
        "Registry record review (observational design)",
        "Frequency/dosimetry parameters of radiofrequency energy not reported in abstract",
        "Potential for unmeasured confounding; matched subgroup details not provided in abstract"
    ],
    "evidence_strength": "moderate",
    "confidence": 0.7399999999999999911182158029987476766109466552734375,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "radiofrequency catheter ablation",
        "atrioventricular block",
        "pediatric",
        "registry",
        "complications",
        "accessory pathways",
        "AV nodal reentrant tachycardia",
        "institutional experience"
    ],
    "suggested_hubs": [
        {
            "slug": "occupational-exposure",
            "weight": 0.1499999999999999944488848768742172978818416595458984375,
            "reason": "Involves radiofrequency energy use in a clinical procedure; not an environmental/telecom exposure study."
        }
    ]
}

Comments

Log in to comment.

No comments yet.