Anterior region of the atrioventricular perinodal area in relation to radiofrequency ablation procedures

Abstract

Atrioventricular nodal reentry tachycardia base on reentry circulation in nodal-perinodal area. The radical treatment of choice is radiofrequency ablation. Procedure approached from the anterior-superior (fast) region sufficient a few seconds of energy delivery for success, however this can result in A-V block. The possibility that arrhythmias substrate may lie very superficially (success of ablation) and damage the normal structures (complication) in the perinodal region must be considered. In order to confirm this hypothesis we examined the autopsy material of 100 normal hearts, both sexes from 18 to 105 years of age (control) and 50 hearts with A-V total block 45-95 years of age (block). We paid attention to the morphology of the nodal artery (NA), atrial inputs (AI) and transitional inputs (TI). It was observed that NA at the level of the central fibrous body was positioned in 94% in the central and in 6% in the inferior part of Koch’s triangle. It was removed from the endocardium 3-6 mm in control and 2-5 mm in block group respectively (NS). In the perinodal area we distinguished AI that directly joined the A-V compact node: superficial (right part of the interatrial septum) or deep (left part). The former occurred in 100% of controls and in 80% of block groups (NS), and the latter in 80% of control group and in 34% in block respectively (p < 0.05). The real substrate of arrhythmia in anterior-superior region lies very superficially and far from the conduction tissue; NA in examined hearts was lying deep beneath the endocardium; ablation close to the node could result in A-V block.