Incidental dual atrioventricular nodal physiology in children and adolescents: clinical follow-up and implications.

BACKGROUND: Dual atrioventricular (AV) nodal physiology is a substrate for the development of AV nodal reentrant tachycardia (AVNRT). However, the risk of developing AVNRT in patients with dual AV nodal physiology is not known. The purpose of this study is to identify the risk of developing AVNRT in children and adolescents with incidental findings of dual AV nodal physiology after accessory pathway ablation.

METHODS: This is a single center retrospective study of patients who underwent intracardiac electrophysiology study at The Children's Hospital, Denver, from March 1993 to August 2008, with findings of dual AV nodal physiology after successful ablation of an accessory pathway. Follow-up was obtained by chart review with the primary outcome of recurrent supraventricular tachycardia. Extended clinical follow-up was also achieved through phone contact with patients or parents of patients.

RESULTS: Mean age at initial electrophysiology study was 12.8 years (±3.7 years). Follow-up was obtained on all 66 patients for a mean duration of 3.1 years (±2.8 years). Mean age at follow-up was 15.8 years (±4.6 years). Recurrent supraventricular tachycardia occurred in nine of the 66 patients (13.6%). AVNRT was induced in two of the 66 patients (3.0%).

CONCLUSION: This study supports the hypothesis that incidental dual AV nodal physiology does not predict AVNRT in children and adolescents with after successful accessory pathway ablation.