Gradual power titration using radiofrequency energy: a safe method for slow-pathway ablation in the setting of atrioventricular nodal re-entrant tachycardia.

Aims: In the setting of atrioventricular nodal re-entrant tachycardia (AVNRT), radiofrequency (RF) catheter ablation of the slow-pathway (SP) ensures excellent outcome. However, the risk of complete heart block (CHB) remains real ( approximately 1%) and detrimental. This study reports on a gradual power titration approach using RF energy, which allows a significant decrease in CHB occurrence.

Clinical examination should not be forgotten when assessing the level of 2/1 AV block.

The authors underline the importance of carrying out a simple clinical examination to assess the level of two-to-one auriculoventricular block before any invasive electrophysiological procedures are performed. Clinical examination can indeed easily distinguish between the two different prognostic entities, represented by nodal and infra-nodal atrioventricular block. This initial evaluation of the severity of conduction disorders, as soon as the patient arrives at the emergency department or attends a consultation, may be greatly helpful in selecting the most appropriate management of those patients.