Objective: This study retrospectively reviews the charts of children with dual atrioventricular (AV) nodal physiology after ablation of an accessory pathway (AP), but whose AV node was not modified. The purpose of this study is to identify the risk of developing atrioventricular nodal reentrant tachycardia (AVNRT) in children with dual AV nodal physiology.

Methods: This is a single center retrospective chart review of patients who underwent intracardiac electrophysiology study (EPS) at The Children’s Hospital, Denver from 1993 to 2008. Patients with AP mediated supraventricular tachycardia (SVT) who underwent ablation of the AP and in whom post-ablation EPS demonstrated dual AV nodal physiology were identified from the electrophysiology database. Last reported follow-up was recorded with the primary outcome being development of SVT. All patients with recurrent SVT underwent repeat EPS.

Results: Of the 77 patients included in the study, follow-up was obtained for a median duration of 1 year 2 months (1m -12 y 3 m). Median age at follow up was 15 years 0 months (6 y 5 m-21 y 3 m). Recurrent SVT occurred in 9 of the 77 patients (11.6%). Recurrent AP mediated tachycardia was found in 7 (9.1%). Of the 7 patients with recurrent AP mediated tachycardia, nonsustained AVNRT was induced in 1 patient (1.3%). AVNRT was induced in 2 patients (2.6%) whose initial accessory pathway ablation was successful. Altogether, AVNRT was found in 3 patients (3.8%) with dual AV nodal physiology.

Conclusions: This study supports the hypothesis that dual AV nodal physiology does not predict AVNRT.