Conventional Atrioventricular Nodal Reentrant Tachycardia Ablation: 16‐Year Acute Outcomes and Pacemaker Requirement
Nail Güven Serbest, Hüseyin Karakurt, Abdurrahman Eren, Hande Uysal, Mehmet Timur Başarıcı, Kadir Sadıkoğlu, Ender Öner, Özgür SürgitAbstract
Background
This study characterized the acute success, causes of failure, and index‐hospitalization permanent pacemaker (PPM) rate of conventional (fluoroscopy‐guided, without 3D electroanatomic mapping [3D‐EAM]) AVNRT ablation over 16 years at a single center.
Methods
Consecutive adult patients (≥18 years) who underwent conventional ablation for AVNRT between January 2010 and May 2026 were retrospectively evaluated. All procedures were performed by a senior operator or under the direct supervision of a senior operator. Acute success was defined as non‐inducibility of AVNRT under isoproterenol. The primary endpoints were index‐hospitalization PPM and acute success. Rates are presented with Wilson 95% confidence intervals (CIs).
Results
Of 1169 SVT cases, 814 (69.6%) underwent AVNRT ablation (age 46.9 ± 13.0 years; 67.0% female). Acute success was 90.3% (735/814; 95% CI 88.07–92.14). Causes of failure ( n = 79): anatomic limitation 40 (50.6%), persistent inducibility 29 (36.7%), AV conduction disturbance 8 (10.1%), patient intolerance 1, atrial fibrillation 1. Anatomic limitation denotes ablation deliberately terminated to protect AV conduction rather than technical failure. High‐grade AV block developed in 8 patients (0.98%); it resolved spontaneously in 5, and a PPM was implanted during the index hospitalization in 3 (0.37%; 95% CI 0.13–1.08). In the three PPM patients, ventricular pacing remained 100% at follow‐up. Acute success showed no significant univariable association with age or sex.
Conclusions
Conventional AVNRT ablation can be performed at an experienced center with high success (90.3%) and a low PPM rate (0.37%). While some AV block events resolved in the laboratory, those that persisted led to a PPM requirement, and AV conduction was not regained in these patients. These findings provide operator‐homogeneous real‐world reference data from a tertiary referral center in Türkiye.