Influence of Age, Gender, and Anatomical Location on Outcomes of Electrophysiology Study and Radiofrequency Catheter Ablation in Atrioventricular Reciprocating Tachycardia: A Single-Center Experience from a Tertiary Care Hospital

Abstract

Objectives: Radiofrequency catheter ablation (RFA) is an established curative intervention for the management of supraventricular tachycardias (SVTs). This study aimed to evaluate our institutional experience with RFA and electrophysiology study (EPS) in patients presenting with atrioventricular reciprocating tachycardia (AVRT), focusing on outcomes in relation to age, gender, and anatomical location of accessory pathways (APs). Methodology: A retrospective, observational study was conducted at the Cardiac Electrophysiology Department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Data were collected for all patients undergoing EPS and RFA for AVRT between July 2017 and July 2023. A total of 415 patients were included, of whom 188 (45.3%) were male. Results: Of the 415 patients, 214 (51.6%) exhibited manifest APs. The most frequently observed APs were located in the left lateral and right free wall regions. Among 39 (16.7%) patients with parahisian APs, only 9 ablation attempts were made due to the proximity to the conduction system, with 5 procedures resulting in successful outcomes. Orthodromic AVRT was identified in 363 patients (87.5%), antidromic AVRT in 41 (9.9%), and both forms in 11 (2.7%). Multiple APs were present in 22 patients (5.3%), and pre-excited atrial fibrillation occurred in 35 patients (8.4%). The overall short-term procedural success rate was 71.5% (n=266), including 3 partial successes. Right-sided APs were significantly more prevalent in female patients (60.8% vs. 50.5%, p=0.036), whereas left-sided APs were more common in male patients (52.1% vs. 39.2%, p=0.008). No significant association was found between patient age and procedural outcome. Conclusion: EPS followed by RFA is a safe and effective therapeutic approach for symptomatic AVRT. Our findings highlight gender-based anatomical differences and support the utility of RFA even in resource-limited settings, as demonstrated in this single-center tertiary care study.