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Objective: Catheter-based modulation of the slow pathway is the first-line therapy of atrioventricular nodal reentrant tachycardia (AVNRT), the most common supraventricular tachycardia (SVT). In patients with a typical history, in whom AVNRT is not inducible during an electrophysiological study, the current guidelines allow consideration of empirical slow pathway modulation (ESPM) under the precondition that both, dual nodal pathway physiology (DNPP) and an ECG documentation compatible with AVNRT exist. This recommendation is based on small series. Furthermore, it is unknown whether ESPM is beneficial in the presence of ECG documentation but the absence of DNPP or vice versa in the presence of DNPP but absence of ECG documentation., Methods: Out of 3003 patients who underwent slow pathway modulation from 1993 to 2013, we included 116 patients (68 female; median age 47.0 years) with symptomatic tachycardia who had non-inducible SVT. All patients either had ECG documentation of SVT (66 %) or DNPP (89 %) or both (54 %). All patients underwent ESPM. No severe complications occurred., Results: After a follow-up time of 64 ± 5.3 months, 81 % of all patients had benefited from ESPM (49 % freedom of symptoms, 32 % improvement). In patients with ECG documentation but absence of DNPP 100 % benefited (85 % freedom of symptoms; 15 % improvement). In patients with DNPP but absence of ECG documentation 75 % benefited (40 % freedom of symptoms, 35 % improvement)., Conclusion: In a large cohort of patients, ESPM is a safe procedure that improves clinical symptoms in the majority of patients during long-term follow-up. We show for the first time that this also applies for cases where there is no DNPP but a characteristic ECG documentation, and vice versa.

Background: Clinically silent lesions on cerebral magnet resonance imaging have been found in larger numbers after pulmonary vein isolation (PVI) especially with phased radio frequency (pRF) using all ten electrodes. However, the neuropsychological effects of cerebral microembolism during the procedure remain unclear and data regarding this issue so far are inconsistent., Methods: Between August 2011 and June 2012, 76 patients undergoing their first PVI were randomized to ablation with either phased (40) or irrigated (36) radio frequency (iRF). A comprehensive neuropsychological test battery was performed the day before and after PVI as well as 6 months after ablation. The occurrence of cerebral microemboli during the procedure was performed via a transcranial Doppler ultrasound device., Results: PVI using pRF was associated with increased number of microembolic signals (MES) compared to iRF (1530.0 ± 979.8 vs. 645.7 ± 448.7; p < 0.001). Neuropsychological assessment did not reveal any changes in correlation with the used ablation technique. Besides an age-related effect there was a diffuse, sub-clinical impairment of neurologic function depending on age and the number of MES., Conclusions: There was no clinical overt cognitive deficit and no significant difference in cognitive function correlating with the used ablation technique. The number of MES correlated with a subtle, diffuse post-procedural impairment of neuropsychological function highlighting the need to reduce microemboli during ablation.