Radiofrequency Catheter Ablation Therapy of Swallowing‐Induced Atrioventricular Nodal Reentrant Tachycardia: Report of Two Cases

Abstract

We describe two patients who presented with a history of recurrent palpitations on swallowing of solid food. The event-recorder and Holter monitoring documented episodic supraventricular tachycardia (SVT) initiated by atrial premature contractions (APCs). During electrophysiological study (EPS), swallowing of solid food consistently induced APCs and their activation sequence, morphology of P wave were suggestive of their right atrial origin in them. Drug challenge did not affect the APC onset during the swallowing. During EPS, slow-fast variety of atrioventricular nodal reentrant tachycardia (AVNRT) was induced and successful radiofrequency (RF) catheter ablation of slow pathway resulted in total relief of their symptoms.

Swallowing‐Induced Atrial Tachyarrhythmias: Prevalence, Characteristics, and the Results of the Radiofrequency Catheter Ablation

“…The PACs provoked by swallowing usually had the same P‐wave morphology as the first beat of the AT. Nine (23%) patients had AF, three had atrioventricular (AV) nodal reentrant tachycardia, 9,30 and the remaining one had bypass tract‐mediated supraventricular tachycardia 18 . Four patients had paroxysmal AF as the only manifesting supraventricular arrhythmia 4,27,29,32 .…”

“…Two patients underwent slow pathway ablation for AV nodal reentrant tachycardia induced by ectopic atrial premature beats, 30 and one patient underwent a surgical excision of a left‐sided bypass tract for an AV reentrant tachycardia induced by atrial premature complexes 18 . In these three patients, ablation resulted in total relief of their symptoms.…”

“…Occasionally patients may have typical AV nodal reentrant tachycardia 30 or AV reciprocating tachycardia, 18 and they can be induced by either AT or single or double PACs provoked by swallowing. Therefore, if the patient has a substrate for a reentrant supraventricular tachycardia, the PACs or AT provoked by swallowing may induce reentry if a critical AH or AV interval is attained.…”

“…Therefore, if the patient has a substrate for a reentrant supraventricular tachycardia, the PACs or AT provoked by swallowing may induce reentry if a critical AH or AV interval is attained. In such cases, the RFCA of the slow pathway or accessory pathway may result in total relief of their symptoms 18,30 …”

“…Because numerous trials of drugs including the ones affecting the sympathetic or parasympathetic tone effects on the arrhythmia resulted in variable success, with no consistent pattern, their management might be frequently disappointing (Table I). 19,28,34 Two patients underwent slow pathway ablation for AV nodal reentrant tachycardia induced by ectopic atrial premature beats, 30 and one patient underwent a surgical excision of a left-sided bypass tract for an AV reentrant tachycardia induced by atrial premature complexes. 18 In these three patients, ablation resulted in total relief of their symptoms.…”