Résultats à long terme de I'ablation par radiofréquence chez les patients présentant des tachycardies par réentrée intranodale

Radiofrequency catheter ablation is considered as the treatment of choice for patients presenting with drug-resistant atrioventricular node reentrant tachycardia (AVNRT). However, few data are available concerning the longterm outcome of patients undergoing such a procedure. The purpose of this retrospective study was to analyze the short and long-term prognosis of these patients in a cohort of 160 consecutive patients with special attention paid to late complications and recurrences according to the result of the procedure (ablation versus modification of the slow pathway). Results: Primary success rate was 99,4%. Incidence of complete atrioventricular block was 1,2% (immediate in 1/160, late in 1/160 cases). Recurrence rate was 8% (13/160) during a mean follow-up of 21 ± 17 months. Most recurrences (11/13) occurred during the first 12 months but 2 recurrences occurred late after the procedure, at 46 and 47 months respectively. All patients with recurrences underwent a second ablation procedure which was successful in all (13/13). Experience of the operator had no significant influence on the recurrence rate (p = 0,14) even if a clear trend was observed (recurrence rate 11,3% for the first 80 patients and 4% for the last 80 patients). Recurrence rate was significantly influenced by age (0/30 in patients >65 years of age versus 13/130 in patients <65 years of age, p = 0,03). Recurrences were more often observed in patients who had slow pathway modification (11,5% versus 4,1% for patients with slow pathway ablation) but the difference did not reach statistical significance (p = 0,08). : Primary success rate was 99,4%. Incidence of complete atrioventricular block was 1,2% (immediate in 1/160, late in 1/160 cases). Recurrence rate was 8% (13/160) during a mean follow-up of 21 ± 17 months. Most recurrences (11/13) occurred during the first 12 months but 2 recurrences occurred late after the procedure, at 46 and 47 months respectively. All patients with recurrences underwent a second ablation procedure which was successful in all (13/13). Experience of the operator had no significant influence on the recurrence rate (p = 0,14) even if a clear trend was observed (recurrence rate 11,3% for the first 80 patients and 4% for the last 80 patients). Recurrence rate was significantly influenced by age (0/30 in patients >65 years of age versus 13/130 in patients <65 years of age, p = 0,03). Recurrences were more often observed in patients who had slow pathway modification (11,5% versus 4,1% for patients with slow pathway ablation) but the difference did not reach statistical significance (p = 0,08). Conclusion: Radiofrequency catheter ablation/modification of the slow pathway is an effective curative form of treatment for patients with AVNRT. Complication rate is low and recurrences are uncommon. Slow pathway modification is sufficient to obtain the desired clinical result in the vast majority of patients.: Radiofrequency catheter ablation/modification of the slow pathway is an effective curative form of treatment for patients with AVNRT. Complication rate is low and recurrences are uncommon. Slow pathway modification is sufficient to obtain the desired clinical result in the vast majority of patients.