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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Efficacy and safety of low-power (20 W) catheter ablation for typical atrioventricular nodal reentrant tachycardia: a prospective multicenter study

  • Lae-Young Jung1
  • Chang Hee Kwon2
  • In Geol Song3
  • Ji Hyun Lee4
  • Minsu Kim5
5 affiliations
  1. 1Division of Cardiology, Jeonbuk National University Hospital and Jeonbuk National University Medical School
  2. 2Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine
  3. 3Department of Cardiology, Konyang University Hospital
  4. 4Cardiovascular Center, Seoul National University Bundang Hospital
  5. 5Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Sejong Hospital
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Abstract

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia. Although catheter ablation is the definitive treatment, atrioventricular (AV) block requiring permanent pacemaker implantation remains a major safety concern.

Objective: To evaluate the efficacy and safety of a low-power (20 W) slow pathway ablation strategy for typical AVNRT.

Methods: In this prospective multicenter study, 203 consecutive patients (mean age 54.4 ± 17.3 years; 59.6% women) underwent slow pathway ablation initiated at 20 W, with power escalation as needed. Variables associated with requiring higher power were analyzed using univariable and multivariable logistic regression.

Results: Initial success at 20 W was achieved in 170 patients (83.7%); 33 patients (16.3%) required higher power, with an overall acute success rate of 99.5%. Compared with patients who achieved success at 20 W, those requiring higher power were younger and had higher pre-ablation heart rates. On univariable analysis, younger age [odds ratio [OR] 0.66 per 10-year increase, 95% confidence interval [CI] 0.54–0.83; p < 0.001] and higher pre-ablation heart rate (OR 1.88 per 10-bpm increase, 95% CI 1.30–2.73; p < 0.001) were associated with the need for higher power. Transient AV block occurred in 1.9% of patients, and no cases of permanent AV block (0%, 95% CI 0%–1.8%) or pacemaker implantation were observed. During 18.3 ± 4.1 months of follow-up, recurrence occurred in two patients (0.9%).

Conclusion: An initial 20 W ablation strategy provides high efficacy with a favorable safety profile and no permanent AV block observed in this cohort. Younger age and a higher baseline heart rate predicted the need for power escalation, supporting an initial low-power approach for AVNRT ablation.

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Cite

BibTeXRIS
BibTeX
@article{jung2026efficacy,
  title = {{Efficacy and safety of low-power (20 W) catheter ablation for typical atrioventricular nodal reentrant tachycardia: a prospective multicenter study}},
  author = {Lae-Young Jung and Chang Hee Kwon and In Geol Song and Ji Hyun Lee and Minsu Kim},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1949109},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1949109/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Efficacy and safety of low-power (20 W) catheter ablation for typical atrioventricular nodal reentrant tachycardia: a prospective multicenter study
AU  - Lae-Young Jung
AU  - Chang Hee Kwon
AU  - In Geol Song
AU  - Ji Hyun Lee
AU  - Minsu Kim
PY  - 2026
DA  - 2026/10/30
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1949109
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1949109/full
AB  - Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia. Although catheter ablation is the definitive treatment, atrioventricular (AV) block requiring permanent pacemaker implantation remains a major safety concern.  Objective: To evaluate the efficacy and safety of a low-power (20 W) slow pathway ablation strategy for typical AVNRT.  Methods: In this prospective multicenter study, 203 consecutive patients (mean age 54.4 ± 17.3 years; 59.6% women) underwent slow pathway ablation initiated at 20 W, with power escalation as needed. Variables associated with requiring higher power were analyzed using univariable and multivariable logistic regression.  Results: Initial success at 20 W was achieved in 170 patients (83.7%); 33 patients (16.3%) required higher power, with an overall acute success rate of 99.5%. Compared with patients who achieved success at 20 W, those requiring higher power were younger and had higher pre-ablation heart rates. On univariable analysis, younger age [odds ratio [OR] 0.66 per 10-year increase, 95% confidence interval [CI] 0.54–0.83; p < 0.001] and higher pre-ablation heart rate (OR 1.88 per 10-bpm increase, 95% CI 1.30–2.73; p < 0.001) were associated with the need for higher power. Transient AV block occurred in 1.9% of patients, and no cases of permanent AV block (0%, 95% CI 0%–1.8%) or pacemaker implantation were observed. During 18.3 ± 4.1 months of follow-up, recurrence occurred in two patients (0.9%).  Conclusion: An initial 20 W ablation strategy provides high efficacy with a favorable safety profile and no permanent AV block observed in this cohort. Younger age and a higher baseline heart rate predicted the need for power escalation, supporting an initial low-power approach for AVNRT ablation.
SN  - 2297-055X
ER  -