Importance of the relationship between sinus cycle length and junctional rhythm cycle length (occured during radiofrequency ablation) in predicting the successful modification of the slow pathway in Atrioventricular Nodal Re-entrant Tachycardias

BACKGROUND: In atrioventricular nodal re-entrant tachycardias (AVNRT), the achievement of Junctional Rhythms (JR) during Radiofrequency Ablation (RF) is a sensitive but non-specific marker of success. Our aim is to analyze prospectively the predictors of non-inducibility of AVNRT, focusing on the characteristics of the JR. METHODS: We included 75 patients with reproducibly inducible AVNRT. Ablation was performed following an electro-anatomical approach. After each application, the induction protocol was repeated. RESULTS: A total of 341 applications were performed. Although the achievement of ≥1 JR was necessary to obtain the non-inducibility, and the cumulative number of junctional beats (CJB) was higher in effective applications, no CJB cut-off was associated with a success rate higher than 75%. After the observation of a significant correlation between the sinus cycle length (CL) pre-RF and the CL of the JR (JR-CL) (c=0.52; p<0.001), the sinus CL pre-RF/JR-CL ratio (CL-ratio) adequately differentiated the successful vs. unsuccessful applications: 1.41±0.23 vs. 1.17±0.2 (p<0.001). In a multivariate analysis, a CBJ 11 (p<0.001) and a CL-ratio 1.25 (p<0.001) were found to be the only independent predictors of success. The combination of ≥ 11 of CJB with a CL ratio ≥ 1.25 achieved non-inducibility in 97% of our patients. CONCLUSION: 1) The specificity of the occurrence of JR as a marker of the successful ablation of AVNRT is increased by the CL-ratio. 2) The achievement of ≥ 11 of CJB with a CL ratio ≥ 1.25 predicts non-inducibility in almost all patients.