Multicenter Outcomes of Catheter Ablation for Atrioventricular Reciprocating Tachycardia Mediated by Twin Atrioventricular Nodes

JACC Clin Electrophysiol. 2022 Mar;8(3):322-330. doi: 10.1016/j.jacep.2021.08.004. Epub 2021 Sep 29.


Objectives: This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular nodes (T-AVRT).

Background: Although catheter ablation for T-AVRT is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure.

Methods: An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT.

Results: Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range: 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava-to-azygous vein continuation (P = 0.11).

Conclusions: T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.

Keywords: catheter ablation; congenital heart disease; heterotaxy syndrome; supraventricular tachycardia.

Publication types

  • Multicenter Study

MeSH terms

  • Atrioventricular Node
  • Cardiomyopathies*
  • Catheter Ablation* / adverse effects
  • Female
  • Fontan Procedure*
  • Humans
  • Male
  • Retrospective Studies
  • Tachycardia, Reciprocating*