The safety and efficacy of slow pathway region visualization strategy in radiofrequency ablation for atrioventricular nodal reentry tachycardia: a multicenter retrospective study

Abstract Background Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of paroxysmal supraventricular tachycardia, and catheter ablation of the atrioventricular node slow pathway (AVNSP) is the standard treatment. However, the AVNSP is located within the Koch triangle, an area with significant anatomical variation. Accurate localization of the AVNSP is critical for the precise implementation of catheter ablation, as it directly impacts the success and safety of the procedure. Objective To investigate the safety and efficacy of radiofrequency ablation for AVNRT guided by a slow-pathway region visualization strategy compared with the conventional ablation strategy. Methods Data from 149 patients undergoing AVNRT ablation across three hospitals in China were retrospectively analyzed. Patients were divided into two groups: the experimental group, which used the slow-pathway region visualization strategy, and the control group, which used the traditional mapping and ablation strategy. Procedural parameters, including the number of ablations, total ablation time, and operative time, were recorded. Clinical follow-up results were also collected to assess safety and efficacy. Results There were 88 patients in the experimental group and 61 patients in the control group. There were no significant differences in baseline characteristics between the two groups. The experimental group showed significantly fewer ablation points (4.8±3.6 vs 8.5±7.7, P=0.003), shorter total ablation time (284±178s vs 408±345s, P=0.028), and shorter operative time (41.4±14.2min vs 51.5±27.2min, P=0.009) compared to the control group. In the control group, 5 patients (8.2%) experienced Atrioventricular (AV) block during the procedure, with 4 recovering during intra-operative observation and 1 developing persistent first-degree atrioventricular block postoperatively. No cases of AV block or other complications were observed in the experimental group. At a mean follow-up of 488±246 days, no AVNRT recurrences were observed in either group. Conclusion Radiofrequency ablation guided by a slow-pathway region visualization strategy provides a safe, effective treatment for AVNRT, reducing procedure times and minimizing the risk of atrioventricular block compared to the conventional strategy.