AV Nodal Reentrant Tachycardia Study (AVNRT)

Localization of the Anterograde and Retrograde Components of the Reentrant Circuit of AV Nodal Reentrant Tachycardia

The purpose of this study is to determine/identify what mechanisms/factors are involved with regard to AV nodal reentrant tachycardia.

Study Overview

• Status: Active, not recruiting
• Conditions: Tachycardia, Atrioventricular Nodal Reentry
• Intervention / Treatment: Procedure: Cardiac Invasive Electrophysiological Study

Detailed Description

HYPOTHESES:

1. The Tendon of Todaro forms a line of block during slow/fast AVNRT preventing the atrial impulse from entering the triangle of Koch (and perhaps providing sufficient time for activation to pass through the coronary sinus coat to activate the posterior extensions of the AV node as is critical to maintenance of tachycardia)
2. The coronary sinus myocardial coat participates in all of the forms of AVNRT. The reentrant circuit is thus not confined within the triangle of Koch and sites remote from the compact AV node could be targeted for ablation reducing the risk of AV conduction block.
3. A model of the reentrant circuit can be created for each patient's tachycardia, using the site of earliest retrograde activation to suggest the retrograde limb and the resetting response to suggest the anterograde limb.

DATA ANALYSIS/STATISTICS:

Resetting and Mapping of AV nodal reentrant tachycardia:

Pacing will be analyzed to see at which sites, the tachycardia can be reset by the latest extra-stimuli (i.e., with the least advancement in local activation). The coupling interval will be compared to the latest extra-stimulus capable of resetting (advancing) the tachycardia from the postero-septal tricuspid annulus.

Ablation Results:

The patients will act as their own reference, since the standard ablation technique in the postero-septal space is being performed first and tested for efficacy. The McNemar test will be applied to compare the efficacy of ablation at the postero-septal tricuspid annulus alone (standard ablation), with the efficacy of this ablation plus ablation within the coronary sinus. From our initial observations, It is anticipated that the additional ablation in the coronary sinus will increase the efficacy of the procedure from <95% to >98%, such that 100 cases should provide sufficient data to reach statistical significance.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73104
      • The University of Oklahoma Health Sciences Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 80 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Ages 16-80
• At least one documented episode of AV nodal reentrant tachycardia
• Patient scheduled for electrophysiology study and catheter ablation for supraventricular tachycardia

Exclusion Criteria:

• Ages < 16 or > 80
• Medical condition significantly increasing risk of extending procedure time or X-ray exposure
• Pregnancy
• Prior ablation with radiation exposure >2 hours
• Electrophysiology study performed without sedation or anesthesia
• Unavailable for follow-up

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Study Arm; Mapping and Ablation	Procedure: Cardiac Invasive Electrophysiological Study; Mapping and localizing of the components of the reentrant circuit as part of the Electrophysiological Study

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
raise the frequency of success to more than 98%	unk

Collaborators and Investigators

• Sponsor: University of Oklahoma
• Investigators: Principal Investigator: Deborah Lockwood, M.D., University of Oklahoma

Study record dates

Study Major Dates

• Study Start: March 1, 2004
• Primary Completion (Anticipated): March 1, 2025
• Study Completion (Anticipated): March 1, 2025

Study Registration Dates

• First Submitted: February 7, 2008
• First Submitted That Met QC Criteria: February 19, 2008
• First Posted (Estimate): February 20, 2008

Study Record Updates

• Last Update Posted (Actual): May 9, 2023
• Last Update Submitted That Met QC Criteria: May 8, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: Paroxysmal supraventricular tachycardia; AVNRT; Atrioventricular; nodal reentrant circuit; nodal reentrant tachycardia
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Arrhythmias, Cardiac; Cardiac Conduction System Disease; Tachycardia, Reciprocating; Tachycardia; Tachycardia, Atrioventricular Nodal Reentry
• Other Study ID Numbers: 2353; AHA (American Heart Association)