Comparison of Heart Rate Variability Parameters Between Slow Pathway Complete Ablation and Modification/Ablation for AVNRT

Document Type : Original Article


1 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences Tehran, IR Iran.

2 Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.

4 Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of supraventricular tachycardia, and catheter slow pathway ablation is the first-line therapy in this arrhythmia. The endpoint for the successful ablation of AVNRT is the noninducibility of the tachycardia rather than the complete ablation or modification/ablation of slow pathways. We aimed to compare heart rate variability (HRV) parameters between slow pathway complete ablation and slow pathway modification/ablation for AVNRT.
Methods: The current study enrolled 78 eligible patients with AVNRT. Slow pathway complete ablation was performed on 49 patients, and 29 patients underwent slow pathway modification/ablation. HRV parameters on 24-hour Holter monitoring were compared before and 30 days after ablation between these 2 groups.
Results: HRV parameters, consisting of the mean heart rate, the standard deviation of normal-to-normal RR intervals over 24 hours (SDNN), the standard deviation of the average NN intervals for all 5-minute intervals in a 24-hour continuous electrocardiographic recording (SDANN), and a percent NN interval exceeding 50 milliseconds from the prior interval (PNN50), were not significantly different in the group with complete slow pathway ablation. The comparison between pre and post-intervention entities revealed statistically significant differences in SDNN (P=0.041) and PNN50 (P=0.008) in the group with slow pathway modification/ablation. Additionally, PNN50 was significantly lower in the modification/ablation group than in the complete ablation group.
Conclusions: We noted negligible differences regarding HRV-associated indices between the slow pathway complete ablation and modification/ablation for AVNRT groups. (Iranian Heart Journal 2023; 24(2): 62-68)


  1. Hanninen M, YEUNG‐LAI‐WAH N, Massel D, Gula LJ, Skanes AC, Yee R, et al. Cryoablation versus RF ablation for AVNRT: a meta‐analysis and systematic review. Journal of cardiovascular electrophysiology. 2013; 24(12):1354-60.
  2. Sugumar H, Chieng D, Prabhu S, Voskoboinik A, Anderson RD, Al‐Kaisey A, et al. A prospective evaluation of the impact of individual RF applications for slow pathway ablation for AVNRT: markers of acute success. Journal of Cardiovascular Electrophysiology. 2021; 32(7):1886-93.
  3. Czosek RJ, Cassedy AE, Wray J, Wernovsky G, Newburger JW, Mussatto KA, et al. Quality of life in pediatric patients affected by electrophysiologic disease. Heart Rhythm. 2015; 12(5):899-908.
  4. Tachibana M, Banba K, Matsumoto K, Ohara M, Nagase S. A safe and simple approach to avoid fast junctional rhythm during ablation in patients with atrioventricular nodal reentrant tachycardia. Journal of Cardiovascular Electrophysiology. 2019; 30(9):1578-85.
  5. Katritsis DG, Zografos T, Siontis KC, Giannopoulos G, Muthalaly RG, Liu Q, et al. Endpoints for successful slow pathway catheter ablation in typical and atypical atrioventricular nodal re-entrant tachycardia: a contemporary, multicenter study. JACC: Clinical Electrophysiology. 2019;5(1):113-9.
  6. Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016; 133(14):e471-e505.
  7. Kesek M, Lindmark D, Rashid A, Jensen SM. Increased risk of late pacemaker implantation after ablation for atrioventricular nodal reentry tachycardia: a 10-year follow-up of a nationwide cohort. Heart Rhythm. 2019; 16(8):1182-8.
  8. Upadhyay S, Valente AM, Triedman JK, Walsh EP. Catheter ablation for atrioventricular nodal reentrant tachycardia in patients with congenital heart disease. Heart Rhythm. 2016; 13(6):1228-37.
  9. Nakagawa H, Jackman WM. Catheter ablation of paroxysmal supraventricular tachycardia. Circulation. 2007; 116(21):2465-78.
  10. Giazitzoglou E, Korovesis S, Kokladi M, Venetsanakos I, Paxinos G, Katritsis DG. Slow-pathway ablation for atrioventricular nodal re-entrant tachycardia with no risk of atrioventricular block. Hellenic J Cardiol. 2010; 51(5):407-12.
  11. Guo H, Wang P, Xing Y, Peng F, Jiang J, Yang B, et al. Delayed injury of autonomic nerve induced by radiofrequency catheter ablation. Journal of Electrocardiology. 2007; 40(4):355. e1-. e4.
  12. Katritsis DG, Zografos T, Katritsis GD, Giazitzoglou E, Vachliotis V, Paxinos G, et al. Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. EP Europace. 2017; 19(4):602-6.
  13. Brembilla-Perrot B, Sellal J-M, Olivier A, Manenti V, Beurrier D, de Chillou C, et al. Recurrences of symptoms after AV node re-entrant tachycardia ablation: a clinical arrhythmia risk score to assess putative underlying cause. International journal of cardiology. 2015; 179:292-6.
  14. Nigro G, Russo V, De Chiara A, Rago A, Cioppa ND, Chianese R, et al. Autonomic nervous system modulation before the onset of sustained atrioventricular nodal reentry tachycardia. Annals of Noninvasive Electrocardiology. 2010; 15(1):49-55.
  15. AŞKIN L, Türkmen S. The Relationship Between Heart Rate Variability Parameters and Atrioventricular Nodal Reentrant Tachycardia. Koşuyolu Heart Journal. 2018; 21(2):128-34.
  16. Guzzetti S, Mayet J, Shahi M, Mezzetti S, Foale R, Sever P, et al. Absence of sympathetic overactivity in Afro-Caribbean hypertensive subjects studied by heart rate variability. Journal of Human Hypertension. 2000; 14(5):337-42.
  17. Sileikiene R, Vaskelyte J, Mizariene V, Nedzelskiene I, Verseckaite R, Jurkevicius R, et al. Heart rate variability and atria function in children at late follow-up evaluation after atrioventricular node slow-pathway radiofrequency ablation. Pediatric cardiology. 2011; 32(6):792-800.
  18. Stern JD, Rolnitzky L, Goldberg JD, Chinitz LA, Holmes DS, Bernstein NE, et al. Meta‐analysis to assess the appropriate endpoint for slow pathway ablation of atrioventricular nodal reentrant tachycardia. Pacing and clinical electrophysiology. 2011; 34(3):269-77.
  19. Reithmann C, Remp T, Oversohl N, Steinbeck G. Ablation for atrioventricular nodal reentrant tachycardia with a prolonged PR interval during sinus rhythm: the risk of delayed higher‐degree atrioventricular block. Journal of cardiovascular electrophysiology. 2006; 17(9):973-9.
  20. Saburi A, Karbasi-Afshar R, Shahmari A, Baghersad-Renani MM. Partial and Complete Ablation of the Slow Pathway in Patients with Atrioventricular Nodal Reentrant Tachycardia: Comparing the Complications and Recurrence. Journal of Mazandaran University of Medical Sciences. 2012; 22(95):29-37.
  21. MANN DE, KELLY PA, ADLER SW, FUENZALIDA CE, REITER MJ. Palpitations occur frequently following radiofrequency catheter ablation for supraventricular tachycardia, but do not predict pathway recurrence. Pacing and Clinical Electrophysiology. 1993; 16(8):1645-9.
  22. Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural orthostatic tachycardia syndrome: JACC focus seminar. Journal of the American College of Cardiology. 2019; 73(10):1207-28.