Left-sided approach of AV junction ablation for drug refractory atrial fibrillation

  • Yoga Yuniadi
  • Retna Dewayani
  • M. Munawar
  • Otte J. Rachman
Keywords: Atrial fibrillation, AV junction ablation, left-sided approach


AV junction ablation has been proven effective to treat symptomatic atrial fibrillation refractory to antiarrhythmias or fail of pulmonary vein isolation. However, about 15% of conventional right-sided approach AV junction ablation failed to produce complete heart block. This study aimed to characterize His bundle potential at ablation site during conventional or left-sided approach of AV junction ablation. Twenty symptomatic AF patient (age of 60.5 ± 9.28 and 11 are females) underwent conventional AV junction ablation. If 10 applications of radiofrequency energy are failed, then the ablation was performed by left-sided approach. Seventeen patients are successfully ablated by conventional approach. In 3 patients, conventional was failed but successfully ablated by left-sided approach. The His bundle amplitude at ablation site was significantly larger in left-sided than correspondence right-sided (16.0 ± 4.99 mm vs. 6.9 ± 4.02 mm respectively, p = 0.001, 95% CI -14.0 to -4.3). ROC analysis of His bundle potential amplitude recorded from right-sided revealed that cut off point of > 4.87 mm given the sensitivity of 81.3% and specificity of 53.8% for successful right-sided approach of AV junction ablation. In case of failed conventional approach, the left-sided approach is effective for AV junction ablation. An early switch to the left-sided approach may avoid multiple RF applications in patients with a low amplitude His-bundle potential (< 4.87 mm). (Med J Indones 2006; 15:109-14)

How to Cite
Yuniadi Y, Dewayani R, Munawar M, Rachman OJ. Left-sided approach of AV junction ablation for drug refractory atrial fibrillation. Med J Indones [Internet]. 2006May1 [cited 2024Feb.23];15(2):109-14. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/220
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