Some (pts) undergoing slow pathway ablation (SPA) continue to feel palpitations mostly due to atrial extra beats which can provoke atrial fibrillation (AF) or recurrence of AV node re-entry tachycardia (AVNRT).
Methods: We perform a retrospective analysis of 211 consecutive pts who underwent SPA in our department to compare the influence of complete SP ablation versus SP modification on the incidence of postablation palpitations and other outcomes.
Baseline characteristics: 61% women, mean age 54.2±14.5 years, mean left ventricular ejection fraction (LVEF) 65.1±7.9%, 32.7% with left atrial enlargement (LAE), 48% with hypertension (HTN), 8.5% with a history of atrial fibrillation (AF), 10% with atypical AVNRT and 6.6% with a history of valvular problems (VP).
Results: The success rate of SPA was 98.6%. In 101 pts (49%) SP was completely ablated. During follow up (FU) period of 34.7±21.9 month 35.1% of the pts continued to experience palpitations. 13 pts (6.2%) developed AF 28±15 months after SPA. Pts who suffer from palpitations in FU period (76 pts, group 1) were significantly younger than pts who not (135 pts, group 2) (51.2±15 vs. 55.9±14 years old, p<0.01), with higher LVEF (67±5% vs. 64±9%, p<0.02) and lower incidence of LAE (21% vs. 39%, p<0.002). There were more females in group 1 (78% vs. 53%, p<0.0001) and more cases with atypical AVNRT (15.8% vs. 6.6%, p<0.016). There were no cases of recurrence or re-do in group 2. Modification of SP was strongly associated with continuing of palpitations among pts from our cohort (45.8% vs. 23.8%, p<0.0013).
Conclusions: In our group of pts post SPA palpitations occurred more often among younger women, and were associated with recurrence of AVNRT or appearance of AF. Complete SPA was strongly associated with lower rate of palpitations during long FU period.
