Electrophysiological findings and long-term follow-up of patients with the permanent form of junctional reciprocating tachycardia treated by catheter ablation.

Abstract

BACKGROUND The permanent form of junctional reciprocating tachycardia (PJRT) commonly presents as recurrent drug-refractory, narrow-complex tachycardia. We studied the efficacy and safety of catheter ablation in treating these patients. METHODS AND RESULTS Six patients with the diagnosis of PJRT were treated at our institution with direct-current catheter ablation. The study cohort comprised three men and three women with a mean age of 33.8 +/- 4.5 years. The mean time from onset of symptoms to ablation was 129 +/- 44.7 months. All failed multiple drug therapy (mean number of drugs failed was 5.3 +/- 0.5). The left ventricular ejection fractions were calculated by echocardiography and were greater than 60% in all except two patients, whose ejection fractions were 25% and 32%. Symptom duration was significantly longer in those with depressed ejection fraction compared with normal patients (258 versus 64.5 months, p less than 0.01). Electrophysiological findings revealed evidence of an atrioventricular reciprocating tachycardia involving retrograde decremental conduction over an accessory pathway localized to the posteroseptal area. Five patients received two direct-current shocks (250 +/- 16.7 J per shock) via paired electrodes from a catheter positioned just outside the coronary sinus os to a patch placed between the scapulae or on the anterior chest wall. One patient received a single direct-current shock of 300 J. The only complication was the development of complete atrioventricular block in one patient. This patient had previously undergone permanent pacemaker insertion for the sick sinus syndrome. The mean hospital stay after ablation was 2.2 days. Mean peak creatinine phosphokinase after ablation was 352 +/- 58.1 units/l and the MB fraction was 12 +/- 2%. Follow-up echocardiograms or gated nuclear studies showed improvement of ejection fraction in the two patients who presented with depressed ejection fractions. After a mean follow-up of 35.8 +/- 10.3 months, all patients remained free of tachycardia without antiarrhythmic drugs. CONCLUSIONS We conclude that catheter ablation by using direct current energy appears to be an effective treatment in patients with PJRT.

Concealed Accessory Pathway with Long Conduction Times and Incremental Properties: A Case Report

“…Another striking feature of this pathway was the absence of VA conduction at baseline (rest and sedated state). This feature was reported by Chien et al, 7 who pointed out that the conduction properties of this pathway are very sensitive to changes in autonomic tone. Their observation matched ours, as we observed that, at baseline, a dominant vagal drive modulated both AV and 1 and 2).…”

Ablation of Atrioventricular Accessory Pathways: Current Technique‐State of the Art

“…Posteroseptal pathways have the highest incidences of antegrade and retrograde decremental conduction. [81][82][83][84][85][86][87] Some patients have clinical presentation of permanent junctional reciprocating tachycardia. Gaita et al 86 reported that in their 32 patients with permanent junctional reciprocating tachycardia, 76% of APS were posteroseptal and 12% were midseptal.…”

Coexistence of the Permanent Form of Junctional Reciprocating Tachycardia and Atrial Tachycardia

“…[1][2][3][4] However, some reports have identified a paroxysmal type of PJRT, such as in the present patient. 5,6 The electrocardiographic feature of PJRT is a narrow QRS tachycardia with a long RP' interval, but atypical forms of AVNRT and AT sometimes demonstrate similar electrocardiographic findings.…”

“…1,2 PJRT is frequently incessant and occasionally tachycardia-induced cardiomyopathy develops. The electrocardiographic feature of PJRT is a narrow QRS tachycardia with a long RP' interval.…”