Research Day

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Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is an arrhythmia due to re-entrant rhythm within the region of the atrioventricular (AV) node, which accounts for most supraventricular tachycardia (SVT) cases in children. There are two main pathways involved for the re-entrant rhythm, slow and fast pathways, with different anatomic locations and involvement in the circuit associated with AVNRT. AVNRT is rare in newborns, but an increase of prevalence throughout childhood was previously reported.Study Objective/Purpose: Currently, Radiofrequency (RF) ablation is the primary method for the treatment of AVNRT in pediatrics. However, multiple modalities with varying efficacies can also be utilized. In this study, we attempt to review indications and complications of the gold-standard use of RF compared to newer modalities for the ablation treatment of AVNRT in the pediatric population. Results/Discussion: Currently there are two transcatheter ablations methods widely applied as AVNRT treatment: RF ablation and Cryoablation (Cryo). Indications for these methods vary with blood flow in the target area, duration of procedure, and risk of recurrence of AVNRT. Both methods have success rates >90% in AVNRT children, with a 3% complication rate. AV block is the most common complication of RF ablation cases, while Cryo, being a newer technology, requires further investigation. Factors that complicate ablation in AVNRT include anatomical and electrophysiological variations between individuals. Fluoroscopic visualization and 3D-voltage mapping of pathways can provide markers for catheter ablation in AVNRT cases to expedite ablation success and enhance safety. Other predictors of success include: reduced fluoroscopy time, lower patient weight, the ability to induce junctional rhythm in the patient during the procedure, and the utilization of image-based guidance and ice-mapping during the ablation. Conclusion: Radiofrequency catheter ablation remains the highly successful gold standard for the treatment of AVNRT in children, with low complication rates. Cryoablation and other advanced techniques are emerging as new methods tailored to the accessory pathways and more sophisticated structural variations underlying AVNRT in children.



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