Mustafa YILDIZ, Can Yücel KARABAY, Ahmet Çağrı AYKAN

Evaluation of cardiac functions after catheter ablation of atrioventricular nodal reentrant tachycardia

Background/aim: Radiofrequency catheter ablation (RFA) is the most effective method of supraventricular tachycardia therapy. Recurrent supraventricular tachycardia causes systolic dysfunction and dilated cardiomyopathy. The aim of this study was to evaluate the long-term alterations of atrial and ventricular functions after RFAof typical atrioventricular nodal reentrant tachycardia (AVNRT). Materials and methods: This cross-sectional study included 55 consecutive patients with symptomatic drug-resistant AVNRT who had had an invasive electrophysiology study and RFA. Speckle-tracking–based echocardiographic assessment was performed shortly before and 1 year after the operation. Left ventricle (LV) and right ventricle (RV) peak systolic strain (PSS) and atrial strain measurements were performed. Results: RFA successfully eliminatedtachyarrhythmia in all patients. LV apical 4-chamber PSS –20.8% (–24.7 to –16.0) vs. –22.8% (–26.6 to –17.0, P < 0.001), LV apical 2-chamber PSS –21.5% (–26.8 to –10.1) vs. –22.0% (–27.8 to –13.7, P < 0.001), LV global PSS –20.4% (–26.4 to –14.4) vs. –23.0% (–27.1 to –2.3, P < 0.001), RV global PSS –26.0% (–30.0 to –18.0) vs. –26.5% (–32.1 to –19.7, P < 0.001), and peak left atrial longitudinal strain 41.0% (19.0–71.8) vs. 54.0% (25.6–82.0, P < 0.001) were significantly improved 1 year after RFA. Conclusion: RFA of AVNRT not only provides relief of palpitations but also improves cardiac functions.Key words: Speckle tracking, AVNRT, tachycardia, strain, ablation

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1. Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. New England Journal of Medicine 1992; 327 (5): 313-318. doi: 10.1056/ NEJM199207303270504
2. Yıldız M, Aykan AC, Kahveci G, Demir S, Özkan M. Transvenous radiofrequency ablation theraphy as an effective and safe method for the treatment of the slow pathway of atrioventricular nodal re-entrant tachycardia. Koşuyolu Heart Journal 2011; 14 (2): 51-55.
3. Gökdeniz T, Aykan AC, Yıldız M, Çelik S. Transvenous radiofrequency ablation therapy in the treatment of arrhythmias: a single center experience. Koşuyolu Heart Journal 2013; 16 (1): 36-41. doi: 10.5578/kkd.4475
4. Raymond-Paquin A, Nattel S, Wakili R, Tadros R. Mechanisms and clinical significance of arrhythmia-induced cardiomyopathy. Canadian Journal of Cardiology 2018; 34 (11): 1449-1460. doi: 10.1016/j.cjca.2018.07.475
5. Corey WA, Markel ML, Hoit BD, Walsh RA. Regression of dilated cardiomyopathy after radiofrequency ablation of incessant supraventricular tachycardia. American Heart Journal 1993; 126 (6): 1469-1473. doi: 10.1016/0002- 8703(93)90549-o
6. Cianciulli TF, Saccheri MC, Lax JA, Bermann AM, Ferreiro DE. Two-dimensional speckle tracking echocardiography for the assessment of atrial function. World Journal Cardiology 2010; 2 (7): 163-170. doi: 10.4330/wjc.v2.i7.163
7. Yıldız M, Aykan AÇ, Karabay CY, Çakal B, Çakal S et al. Assessment of the influence of radiofrequency catheter ablation of the slow pathway of theatrioventricular node on cardiac function in patients with atrioventricular nodal reentrant tachycardia: a speckle tracking echocardiography study. Türk Kardiyoloji Derneği Arşivi 2014; 42 (5): 444-449. doi: 10.5543/ tkda.2014.77905
8. Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. Journal of American Society of Echocardiography 2010; 23 (4): 351-369. doi: 10.1016/j.echo.2010.02.015
9. Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB et al. 2015 ACC/AHA/HRSGuideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and Heart Rhythm Society. Journal of the AmericanCollege of Cardiology 2016; 67 (13): 1575-1623. doi: 10.1016/j.jacc.2015.09.019
10. Spinale FG, Zellner JL, Tomita M, Crawford FA, Zile MR. Relation between ventricular and myocyte remodeling with the development and regression of supraventricular tachycardia induced cardiomyopathy. Circulation Research 1991; 69 (4): 1058-1067. doi: 10.1161/01.res.69.4.1058
11. Tomita M, Spinale FG, Crawford FA, Zile MR. Changes in left ventricular volume, mass and function during development and regression of supraventricular tachycardia induced cardiomyopathy. Circulation 1991; 83 (2): 635-644. doi: 10.1161/01.cir.83.2.635
12. Spinale FG, Zellner JL, Tomita M, Tempel GE, Crawfor FA et al. Tachycardia-induced cardiomyopathy: effects on blood flow and capillary structure. American Journal of Physiology 1991; 261: 140-148. doi: 10.1152/ajpheart.1991.261.1.H140
13. Zipes DP. Electrophysiological remodeling of heart owing to rate. Circulation 1997; 95 (7): 1745-1748. doi: 10.1161/01. cir.95.7.1745
14. Thomas L, McKay T, Byth K, Marwick TH. Abnormalities of left atrial function after cardioversion: an atrial strain rate study. Heart 2007; 93 (1): 89-95. doi: 10.1136/hrt.2006.088609
15. Mele D, Alboni, Fuca G, Scarfò S, Paparella N et al. Atrioventricular nodal versus atrioventricular supraventricular reentrant tachycardias: characterization by an integrated Doppler electrophysiological hemodynamic study. Pacing and Clinical Electrophysiology 2000; 23 (12): 2078-2085. doi: 10.1111/j.1540-8159.2000.tb00780.x
16. Majewski J, Lelakowski J, Jedrzejoeski D. The effects of radiofrequency ablation on left atrial systolic function in patients with atrioventricular nodal reentrant and atrioventricular reentrant tachycardias. Kardiologia Polska 2011; 69 (2): 116-122.
17. Lelakowski J, Dreher A. Influence of the treatment of the nodal reentrant tachycardia by RF catheter ablation on selected hemodynamic parameters of left ventricular systolic and diastolic function and exercise capacity. Polski Merkuriusz Lekarski 2009; 26 (156): 600-604.
18. Jinbo Y, Kobayashi Y, Miyata A, Chiyoda K, Nakagawa H et al. Decreasing parasympathetic tone activity and proarrhythmic effect after radiofrequency catheter ablation differences in ablation site. Japanese Circulation Journal 1998; 62 (10): 733- 740. doi: 10.1253/jcj.62.733
19. Fishberger SB, Colan SD, Saul JP, Mayer JE Jr, Wlash EP. Myocardial mechanics before and after ablation of chronic tachycardia. Pacing and Clinical Electrophysiology 1996; 19 (1): 42-49. doi: 10.1111/j.1540-8159.1996.tb04789.x
20. Soejima K, Akaishi M, Mitamura H, Ogawa S, Sakurada H et al. Increase in heart rate after radiofrequency catheter ablation is mediated by parasympathetic nervous withdrawal and related to site of ablation. Journal of Electrocardiology 1997; 30 (3): 239-426. doi: 10.1016/s0022-0736(97)80009-x