Recurrent tachycardia after selective ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia.

Recurrence rate of atrioventricular (AV) nodal reentrant tachycardia after successful radiofrequency ablation varies widely, and the determinants of recurrent AV nodal reentrant tachycardia remain controversial. Furthermore, true or pseudorecurrence of tachycardia after successful ablation in patients with different forms of AV nodal reentrant tachycardia has not been evaluated systematically. Three hundred sixty-two patients (161 men and 201 women [mean age 52 +/- 16 years]), including 314 patients with typical-form, 10 patients with atypical-form, 4 patients with variant-form, and 34 patients with multiple-form AV nodal reentrant tachycardias, received selective radiofrequency ablation of the anterograde and/or retrograde slow AV nodal pathway. During a mean follow-up of 27 +/- 11 months, 9 patients (2.5%) experienced recurrent AV nodal reentrant tachycardia (true recurrence, group A), and 8 (2.2%) had inappropriate sinus tachycardia or paroxysmal atrial tachyarrhythmias (pseudorecurrence, group B). Neither the true nor pseudorecurrence rate was different among the 4 different forms of tachycardia. Factors including presence of residual slow pathway conduction, a single AV nodal reentrant echo beat, absence of an accelerated junctional rhythm during successful ablation, facilitating induction of tachycardia by isoproterenol, radiofrequency pulse number, and successful ablation site were not associated with an increased risk of recurrent AV nodal reentrant tachycardia. The onset time of recurrent tachycardia was significantly late in group B patients (30 +/- 21 vs 292 +/- 240 days, p = 0.04). Thus, this study demonstrated that both true and pseudorecurrence could occur after successful ablation.