{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:18:03Z","timestamp":1788247083590,"version":"build-2803163510"},"reference-count":41,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arrhythm Electrophysiol Rev"],"abstract":"<jats:p>Background: Atrioventricular (AV) conduction ablation has been achieved by targeting the area of penetration of the conduction axis as defined by recording a His bundle potential. Ablation of the His bundle may reduce the possibility of a robust junctional escape rhythm. It was hypothesised that specific AV nodal ablation is feasible and safe. Methods: The anatomical position of the AV node in relation to the site of penetration of the conduction axis was identified as described in dissections and histological sections of human hearts. Radiofrequency (RF) ablation was accomplished based on the anatomical criteria. Results: Specific anatomical ablation of the AV node was attempted in 72 patients. Successful AV nodal ablation was accomplished in 63 patients (87.5%), following 60\u00a0minutes (IQR 50\u201370\u00a0minutes) of procedure time, 3.4\u00a0minutes (IQR 2.4\u20135.5\u00a0minutes) of fluoroscopy time, and delivery of 4 (IQR 3\u20136) RF lesions. \u0391n escape rhythm was present in 45 patients (71%), and the QRS complex was similar to that before ablation in all 45 patients. Atropine was administered in six patients after the 10-min waiting period and did not result in restoration of conduction. In nine patients, AV conduction could not be interrupted, and AV block was achieved with ablation of the His after delivery of 12 (IQR 8\u201315) RF lesions. No cases of sudden death were encountered, and all patients had persistent AV block during a median 10.5\u00a0months (IQR 5\u201314\u00a0months) of follow-up. Conclusion: Anatomical ablation of the AV node is feasible and safe, and results in an escape rhythm similar to that before ablation.<\/jats:p>","DOI":"10.15420\/aer.2024.13","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T09:45:33Z","timestamp":1724147133000},"source":"Crossref","is-referenced-by-count":9,"title":["Anatomical Ablation of the Atrioventricular Node"],"prefix":"10.15420","volume":"13","author":[{"given":"Demosthenes G","family":"Katritsis","sequence":"first","affiliation":[{"name":"Hygeia Hospital, Athens, Greece; Johns Hopkins Hospital, Baltimore, MD, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos C","family":"Siontis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharad","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Papworth Hospital NHS Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros","family":"Stavrakis","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Oklahoma, Oklahoma City, OK, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Giazitzoglou","sequence":"additional","affiliation":[{"name":"Hygeia Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hina","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E","family":"Marine","sequence":"additional","affiliation":[{"name":"Johns Hopkins Hospital, Baltimore, MD, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin T","family":"Tretter","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Cleveland Clinic Children\u2019s, and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian","family":"Sanchez-Quintana","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Human Anatomy and Cell Biology, University of Extremadura, Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H","family":"Anderson","sequence":"additional","affiliation":[{"name":"Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Calkins","sequence":"additional","affiliation":[{"name":"Johns Hopkins Hospital, Baltimore, MD, US; 3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, US"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"key":"ref0","unstructured":"Kay GN, Ellenbogen KA, Giudici M, et al. The Ablate and Pace Trial: a prospective study of catheter ablation of the AV conduction system and permanent pacemaker implantation for treatment of atrial fibrillation. APT Investigators. J Interv Card Electrophysiol 1998;2:121\u201335. https:\/\/doi.org\/10.1023\/a:1009795330454; PMID:\u00a09870004."},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Yeung-Lai-Wah JA, Alison JF, Lonergan L, et al. High success rate of atrioventricular node ablation with radiofrequency energy. 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Two hearts beating as one: radiofrequency ablation of the His bundle in a heterotopic heart transplant patient. Pacing Clin Electrophysiol 1996;19:374\u20135. https:\/\/doi.org\/10.1111\/j.1540-8159.1996.tb03343.x; PMID:\u00a08657602.","DOI":"10.1111\/j.1540-8159.1996.tb03343.x"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Vaksmann G, Lacroix D, Klug D. Radiofrequency ablation of the His bundle for malignant atrial flutter after Mustard procedure for transposition of the great arteries. Am J Cardiol 1996;77:669\u201370. https:\/\/doi.org\/10.1016\/s0002-9149(97)89332-0; PMID:\u00a08610628.","DOI":"10.1016\/s0002-9149(97)89332-0"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Buys EM, van Hemel NM, Jessurun ER, et al. VDDR pacing after His-bundle ablation for paroxysmal atrial fibrillation: a pilot study. Pacing Clin Electrophysiol 1998;21:1869\u201372. https:\/\/doi.org\/10.1111\/j.1540-8159.1998.tb00004.x; PMID:\u00a09793081.","DOI":"10.1111\/j.1540-8159.1998.tb00004.x"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Edner M, Caidahl K, Bergfeldt L, et al. Prospective study of left ventricular function after radiofrequency ablation of atrioventricular junction in patients with atrial fibrillation. Br Heart J 1995;74:261\u20137. https:\/\/doi.org\/10.1136\/hrt.74.3.261; PMID:\u00a07547020.","DOI":"10.1136\/hrt.74.3.261"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Trohman RG, Simmons TW, Moore SL, et al. Catheter ablation of the atrioventricular junction using radiofrequency energy and a bilateral cardiac approach. Am J Cardiol 1992;70:1438\u201343. https:\/\/doi.org\/10.1016\/0002-9149(92)90296-b; PMID:\u00a01442615.","DOI":"10.1016\/0002-9149(92)90296-b"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Heinz G, Siostrzonek P, Kreiner G, Gossinger H. Improvement in left ventricular systolic function after successful radiofrequency His bundle ablation for drug refractory, chronic atrial fibrillation and recurrent atrial flutter. Am J Cardiol 1992;69:489\u201392. https:\/\/doi.org\/10.1016\/0002-9149(92)90991-7; PMID:\u00a01736612.","DOI":"10.1016\/0002-9149(92)90991-7"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Jensen SM, Bergfeldt L, Rosenqvist M. Long-term follow-up of patients treated by radiofrequency ablation of the atrioventricular junction. Pacing Clin Electrophysiol 1995;18:1609\u201314. https:\/\/doi.org\/10.1111\/j.1540-8159.1995.tb06982.x; PMID:\u00a07491304.","DOI":"10.1111\/j.1540-8159.1995.tb06982.x"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Nam MCY, O\u2019Sullivan P, Tonchev I, et al. His bundle combined with deep septal left bundle branch area pacing for atrial fibrillation prior to atrioventricular node ablation. J Arrhythm 2023;39:27\u201333. https:\/\/doi.org\/10.1002\/joa3.12800; PMID:\u00a036733330.","DOI":"10.1002\/joa3.12800"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Morady F, Calkins H, Langberg JJ, et al. A prospective randomized comparison of direct current and radiofrequency ablation of the atrioventricular junction. J Am Coll Cardiol 1993;21:102\u20139. https:\/\/doi.org\/10.1016\/0735-1097(93)90723-e; PMID:\u00a08417049.","DOI":"10.1016\/0735-1097(93)90723-e"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Anderson RH, Sanchez-Quintana D, Mori S, et al. Re-evaluation of the structure of the atrioventricular node and its connections with the atrium. Europace 2020;22:821\u201330. https:\/\/doi.org\/10.1093\/europace\/euaa031; PMID:\u00a032304217.","DOI":"10.1093\/europace\/euaa031"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Tretter JT, Spicer DE, Sanchez-Quintana D, et al. Miniseries 1 \u2013 part III: \u2018behind the scenes\u2019 in the triangle of Koch. Europace 2022;24:455\u201363. https:\/\/doi.org\/10.1093\/europace\/euab285; PMID:\u00a034999775.","DOI":"10.1093\/europace\/euab285"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Darpo B, Walfridsson H, Aunes M, et al. Incidence of sudden death after radiofrequency ablation of the atrioventricular junction for atrial fibrillation. Am J Cardiol 1997;80:1174\u20137. https:\/\/doi.org\/10.1016\/s0002-9149(97)00635-8; PMID:\u00a09359545.","DOI":"10.1016\/s0002-9149(97)00635-8"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Wang RX, Lee HC, Li JP, et al. Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation. Clin Cardiol 2017;40:18\u201325. https:\/\/doi.org\/10.1002\/clc.22600; PMID:\u00a027748530.","DOI":"10.1002\/clc.22600"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Geelen P, Brugada J, Andries E, Brugada P. Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. Pacing Clin Electrophysiol 1997;20:343\u20138. https:\/\/doi.org\/10.1111\/j.1540-8159.1997.tb06179.x; PMID:\u00a09058872.","DOI":"10.1111\/j.1540-8159.1997.tb06179.x"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Peters RH, Wever EF, Hauer RN, et al. Bradycardia dependent QT prolongation and ventricular fibrillation following catheter ablation of the atrioventricular junction with radiofrequency energy. Pacing Clin Electrophysiol 1994;17:108\u201312. https:\/\/doi.org\/10.1111\/j.1540-8159.1994.tb01358.x; PMID:\u00a07511225.","DOI":"10.1111\/j.1540-8159.1994.tb01358.x"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Waldmann V, Marijon E, Combes N. Holter-monitored sudden cardiac arrest after atrioventricular junction ablation. Pacing Clin Electrophysiol 2018;41:422\u20134. https:\/\/doi.org\/10.1111\/pace.13140; PMID:\u00a028617967.","DOI":"10.1111\/pace.13140"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation 2000;101:1138\u201344. https:\/\/doi.org\/10.1161\/01.cir.101.10.1138; PMID:\u00a010715260.","DOI":"10.1161\/01.cir.101.10.1138"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Wang RX, Lee HC, Hodge DO, et al. Effect of pacing method on risk of sudden death after atrioventricular node ablation and pacemaker implantation in patients with atrial fibrillation. Heart Rhythm 2013;10:696\u2013701. https:\/\/doi.org\/10.1016\/j.hrthm.2013.01.021; PMID:\u00a023333719.","DOI":"10.1016\/j.hrthm.2013.01.021"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Macias Y, Tretter JT, Anderson RH, et al. Miniseries 1-part IV: How frequent are fasciculo-ventricular connections in the normal heart? Europace 2022;24:464\u201372. https:\/\/doi.org\/10.1093\/europace\/euab286; PMID:\u00a034999781.","DOI":"10.1093\/europace\/euab286"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Katritsis D, Tretter JT, Marine JE, et al. Quantitative assessment of the fast pathway in atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2023;66:991\u20136. https:\/\/doi.org\/10.1007\/s10840-022-01408-5; PMID:\u00a036355272.","DOI":"10.1007\/s10840-022-01408-5"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Kawashima T, Sasaki H. Gross anatomy of the human cardiac conduction system with comparative morphological and developmental implications for human application. 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J Interv Card Electrophysiol 2002;7:39\u201352. https:\/\/doi.org\/10.1023\/a:1020816016042; PMID:\u00a012391419."},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Mazgalev TN, Tchou PJ. Surface potentials from the region of the atrioventricular node and their relation to dual pathway electrophysiology. Circulation 2000;101:2110\u201317. https:\/\/doi.org\/10.1161\/01.cir.101.17.2110; PMID:\u00a010790355.","DOI":"10.1161\/01.cir.101.17.2110"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Berte B, Hilfiker G, Mahida S, et al. High-resolution parahisian mapping and ablation using microelectrode embedded ablation catheters. Heart Rhythm 2022;19:548\u201359. https:\/\/doi.org\/10.1016\/j.hrthm.2021.12.006; PMID:\u00a034896623.","DOI":"10.1016\/j.hrthm.2021.12.006"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Pandozi C, Botto GL, Loricchio ML, et al. High-density mapping of Koch\u2019s triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential. J Cardiovasc Electrophysiol 2024;35:379\u201388. https:\/\/doi.org\/10.1111\/jce.16168; PMID:\u00a038185855.","DOI":"10.1111\/jce.16168"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Di C, Wang Q, Wu Y, et al. The underrecognized and neglected compact atrioventricular nodal potential: clinical significance for preventing atrioventricular block during so-called slow pathway radiofrequency ablation. J Interv Card Electrophysiol 2024;67:165\u201374. https:\/\/doi.org\/10.1007\/s10840-023-01597-7; PMID:\u00a037330428.","DOI":"10.1007\/s10840-023-01597-7"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Katritsis DG, Zografos T, Siontis KC, et al. End-points for successful slow pathway catheter ablation in typical and atypical atrioventricular nodal reentrant tachycardia: a multicenter study. JACC Clin Electrophysiol 2019;5:113\u201319. https:\/\/doi.org\/10.1016\/j.jacep.2018.09.012; PMID:\u00a030678775.","DOI":"10.1016\/j.jacep.2018.09.012"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Cabrera J\u00c1, Anderson RH, Macias Y, et al. Variable arrangement of the atrioventricular conduction axis within the triangle of Koch: implications for permanent His bundle pacing. 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