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Vijay S, Bansal R, Kidambi BR, Naik N. A unique location of the accessory pathway in a child with permanent junctional reciprocating tachycardia. Pacing Clin Electrophysiol 2024; 47:925-928. [PMID: 37971873 DOI: 10.1111/pace.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Permanent junctional reciprocating tachycardia (PJRT) is a rare supra ventricular tachycardia (SVT) due to an accessory pathway (AP), characterized by slow and decremental retrograde conduction, which is predominantly seen in infants and children. Although the typical site of AP in PJRT is a right posteroseptal region around or just within the coronary sinus (CS), atypical sites of AP have been described. We report a rare case of PJRT in a 7-year-old girl with an AP located in the superio-paraseptal (Para-Hsian) region that was successfully ablated through a non-coronary sinus.
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Affiliation(s)
| | - Raghav Bansal
- Department of cardiology, U N Mehta Institute of Cardiology & Research Centre, Ahmedabad, India
| | - Bharath Raj Kidambi
- Department of Cardiology, SRM Medical College Hospital and Research Center, Chennai, India
| | - Nitish Naik
- Department of cardiology, All India Institute of Medical Sciences, New Delhi, India
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2
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Kohli U, Hassan S, Mercer C, Rhodes L. Permanent junctional reciprocating tachycardia due to an atypical retrograde slow conducting decremental left posterolateral accessory pathway and tachycardia-induced cardiomyopathy in a pregnant adolescent. Pacing Clin Electrophysiol 2024. [PMID: 38491748 DOI: 10.1111/pace.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/28/2024] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT) due to a retrograde slow conducting decremental accessory pathway (AP) which is often incessant and can lead to tachycardia-induced cardiomyopathy (TIC). We report the challenging clinical course of a pregnant adolescent with PJRT due to an atypical retrograde slow conducting decremental left posterolateral AP. Pregnancy is known to exacerbate supraventricular arrhythmias and can lead to adverse maternal and fetal outcomes. To the best of our knowledge, there are no prior reports on the clinical course of rare incessant and difficult-to-treat arrhythmias such as PJRT in a pregnant adolescent patient.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, Morgantown, Washington, USA
| | - Sohail Hassan
- Department of Cardiac Electrophysiology, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Christopher Mercer
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, Morgantown, Washington, USA
| | - Larry Rhodes
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, Morgantown, Washington, USA
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3
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Kamali H, Kafali HC, Caran B, Sulu A, Ergul Y. Coronary sinus ablations in pediatric patients with supraventricular arrhythmias. J Interv Card Electrophysiol 2023; 66:2153-2164. [PMID: 37864653 DOI: 10.1007/s10840-023-01675-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Intracoronary sinus ablations have been performed for various arrhythmical substrates. The aim of this study is to report our experience on pediatric patients of the safety and efficacy of ablations in the coronary sinus. METHODS This is a retrospective study of all patients who underwent ablations in the coronary sinus from October 2013 to October 2021 at a single center. Clinical presentation, type of arrhythmia causing tachycardia, ablation procedure, and outcome were recorded. RESULTS A total of 27 patients were included in the study. Nineteen (69%) of those followed up received a diagnosis of Wolff-Parkinson-White syndrome (WPW), 4 (15%) were cases of supraventricular tachycardia with concealed accessory pathway (AP), 2 (8%) were cases of focal atrial tachycardia, and 2 (8%) were cases of permanent junctional reciprocating tachycardia. Negative delta wave was noteworthy especially in lead II in 11/19 (58%) cases and coronary sinus diverticulum was detected in the WPW cases. Of those with manifest AP (19 cases), 15 (79%) had a high-risk AP and the AP in all WPW cases was adenosine unresponsive. Radiofrequency (RF) catheter ablation was performed in 25/27 (93%) cases during the procedure, and 16/25 (64%) of these were irrigated RF catheters. No complications were observed in the follow-up, including coronary artery injury. CONCLUSIONS Catheter ablation of supraventricular tachyarrhythmias can be accomplished effectively and potentially safely within the coronary sinus. Coronary sinus diverticula should be suspected in patients with manifest posteroseptal APs who have a previous failed ablation and typical electrocardiographic signs.
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Affiliation(s)
- Hacer Kamali
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey.
| | - H Candas Kafali
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
| | - Bahar Caran
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
| | - Ayşe Sulu
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
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4
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Radiofrequency catheter ablation of patients with permanent junctional reciprocating tachycardia and long-term follow-up results. J Interv Card Electrophysiol 2021; 63:461-469. [PMID: 34476675 DOI: 10.1007/s10840-021-01057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of atrioventricular re-entrant tachycardia. We report the clinical and electrophysiological properties of PJRT and outcomes of radiofrequency catheter ablation (RCA) in a large group of patients. METHODS We included 62 patients with the diagnosis of PJRT. Radiofrequency catheter ablation was performed in all. RESULTS Location of accessory pathway was right posteroseptal in 37 (59,7%) cases, right midseptal in 3 (4,8%), left posterior in 7 (11,3%), left lateral in 5 (8,1%), left posterolateral in 3 (4,8%), left anterolateral in 2 (3,2%), left posteroseptal in 2 (3,2%), middle cardiac vein in 2 (3,2%), and left coronary cusp in 1 (1,6%). Single procedure success rate was 90.3%. None of patients had recurrence during follow-up after repeat ablations. Overall long-term success rate was 98.4%. Left ventricular systolic function recovered in all patients with tachycardia-induced cardiomyopathy (TIC). CONCLUSION Retrograde decremental accessory pathways are mainly located in posteroseptal region. Radiofrequency catheter ablation is a safe and effective approach in patients with PJRT.
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5
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Cunningham JM, Borne R. Taking Time With the RP Interval in Narrow Complex Tachycardia. JAMA Intern Med 2021; 181:988-989. [PMID: 34028502 DOI: 10.1001/jamainternmed.2021.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John M Cunningham
- Division of Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado.,Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Ryan Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
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6
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Singleton MJ, Koneru JN, Bhave PD, Whalen SP. An Incessant Tachycardia: What Is the Mechanism? J Innov Card Rhythm Manag 2021; 12:4477-4481. [PMID: 33959407 PMCID: PMC8095334 DOI: 10.19102/icrm.2021.120407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022] Open
Abstract
A 39-year-old man presented with lifelong palpitations, a mildly reduced left ventricular ejection fraction, and incessant tachycardia. Electrocardiography revealed a regular, one-to-one supraventricular tachycardia with superiorly directed P-waves and a long R–P interval. The differential diagnosis of the tachycardia, response to invasive electrophysiologic maneuvers, and treatment with catheter ablation are discussed.
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Affiliation(s)
- Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jayanthi N Koneru
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VI, USA
| | - Prashant D Bhave
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Patrick Whalen
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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7
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Abstract
In some cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic properties related to their specific anatomy. Most of these fibers, which may be responsible for variants of ventricular preexcitation, show decremental conduction properties due to a nodelike aspect or a peculiar tortuous anatomic route across the atrioventricular groove. Moreover, some fibers do not actively sustain any reentrant circuit and can be only involved as bystander in other arrhythmias. Although rare, these accessory pathway variants should be properly diagnosed using noninvasive and invasive methods to guide catheter ablation procedures when needed.
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8
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Galvão RDC, Pucci JPV, Vieira OG. Atypical location of Coumel Tachycardia in Adult: Case Report. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i3.3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Coumel Tachycardia or Incessant Junctional Reentrant (IJRT) generally affects the infant-juvenile population and is characterized by tachycardia due to atrioventricular reentry (AV) mediated by an exclusive, slow, decremental retrograde conduction pathway mostly located in the posterosseptal region of the tricuspid ring. Case report: The present study reported the case of an adult, 49 years old, with IJRT of atypical location. The patient reported feeling palpitations for 5 years with worsening in the last 6 months. After one of his seizures, an electrocardiogram (ECG) documented tachycardia due to AV reentry with a long RP ‘interval. Subjected to an electrophysiological study, an accessory pathway of exclusive retrograde conduction with decreasing characteristics was observed, located in the right mid-septal region. There was easy induction of IJRT, remaining sustained throughout the study. A radiofrequency ablation was performed in the mid-septal D region with interruption of tachycardia, with no more atrioventricular retrograde conduction, the procedure ended without complications. Discussion: Interestingly, the case described differs both in terms of the age range of the most frequent involvement of the IJRT (children and young people), as well as the most common location of the accessory pathway (posterior and postero-septal region of the tricuspid ring). Ablation proved to be effective in this case and is the treatment of choice for IJRT despite the anomalous location of the accessory pathway (Middle-septal D: described in bibliographic reviews in only 7% of IJRT cases) and a potentially dangerous region due to proximity to the trunk of the His beam.
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9
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Oesterle A, Lee AC, Voskoboinik A, Moss JD, Vedantham V, Walters TE, Lee BK, Tseng ZH, Gerstenfeld EP, Scheinman MM. Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology. J Cardiovasc Electrophysiol 2020; 31:3232-3242. [PMID: 33107135 DOI: 10.1111/jce.14788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia (SVT), typically involving a single decremental posteroseptal accessory pathway (AP). METHODS Four patients with long RP SVT underwent electrophysiology (EP) study and ablation. The cases were reviewed. RESULTS Case 1 recurred despite 3 prior ablations at the site of earliest retrograde atrial activation during orthodromic reciprocating tachycardia (ORT). Mapping during a repeat EP study demonstrated a prepotential in the coronary sinus (CS). Ablation over the earliest atrial activation in the CS resulted in dissociation of the potential from the atrium during sinus rhythm. The potential was traced back to the CS os and ablated. Case 2 underwent successful ablation at 6 o'clock on the mitral annulus (MA). ORT recurred and successful ablation was performed at 1 o'clock on the MA. Case 3 had tachycardia with variation in both V-A and A-H intervals which precluded the use of usual maneuvers so we used simultaneous atrial and ventricular pacing and introduced a premature atrial contraction with a closely coupled premature ventricular contraction. Case 4 had had two prior atrial fibrillation ablations with continued SVT over a decremental atrioventricular bypass tract that was successfully ablated at 5 o'clock on the tricuspid annulus. A second SVT consistent with a concealed nodoventricular pathway was successfully ablated at the right inferior extension of the AV nodal slow pathway. CONCLUSION We describe challenging cases of PJRT by virtue of complex anatomy, diagnostic features, and multiple arrhythmia mechanisms.
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Affiliation(s)
- Adam Oesterle
- Division of Cardiovascular Medicine, Department of Medicine, University of California Davis, Sacramento, California, USA
| | - Adam C Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aleksandr Voskoboinik
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joshua D Moss
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Vasanth Vedantham
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tomos E Walters
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Byron K Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Melvin M Scheinman
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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10
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Boulé S, Détis N, Lamblin N. Permanent junctional reciprocating tachycardia: a rare, but not to be missed, cause of cardiogenic shock in adults. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 9:NP3-NP5. [PMID: 27798173 DOI: 10.1177/2048872616676604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of a 64-year-old woman who was admitted for cardiogenic shock caused by a permanent junctional reciprocating tachycardia. If this incessant and drug-refractory form of tachycardia is a well-known cause of tachycardia-induced cardiomyopathies in infants, its occurrence during adulthood is extremely rare. Catheter ablation is the recommended treatment of this condition.
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Affiliation(s)
- Stéphane Boulé
- Cardiac Intensive Care Unit, Lille University Hospital, France
- Department of Electrophysiology, Lille University Hospital, France
| | - Nicolas Détis
- Department of Electrophysiology, Lille University Hospital, France
- Department of Cardiology, Polyclinique du Bois, France
| | - Nicolas Lamblin
- Cardiac Intensive Care Unit, Lille University Hospital, France
- Inserm U1167, Université Lille Nord de France, France
- Lille University School of Medicine, Lille, France
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11
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Soares Correa F, Lokhandwala Y, Sánchez-Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E. Unusual variants of pre-excitation: From anatomy to ablation: Part III-Clinical presentation, electrophysiologic characteristics, when and how to ablate nodoventricular, nodofascicular, fasciculoventricular pathways, along with considerations of permanent junctional reciprocating tachycardia. J Cardiovasc Electrophysiol 2019; 30:3097-3115. [PMID: 31646696 DOI: 10.1111/jce.14247] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022]
Abstract
The recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, but frequently a difficult, challenge for the clinical cardiac arrhythmologist. In this third part of our series of reviews, we discuss the different steps required to come to the correct diagnosis and management decision in patients with nodofascicular, nodoventricular, and fasciculo-ventricular pathways. We also discuss the concealed accessory atrioventricular pathways with the properties of decremental retrograde conduction that are associated with the so-called permanent form of junctional reciprocating tachycardia. Careful analysis of the 12-lead electrocardiogram during sinus rhythm and tachycardias should always precede the investigation in the catheterization room. When using programmed electrical stimulation of the heart from different intracardiac locations, combined with activation mapping, it should be possible to localize both the proximal and distal ends of the accessory connections. This, in turn, should then permit the determination of their electrophysiologic properties, providing the answer to the question "are they incorporated in a tachycardia circuit?". It is this information that is essential for decision-making with regard to the need for catheter ablation, and if necessary, its appropriate site.
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Affiliation(s)
- Frederico Soares Correa
- Post Graduation Department, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.,Arrhythmia and Electrophysiology Department, Biocor Institute, Nova Lima, Brazil
| | | | | | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre Maastricht, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Post Graduation Department, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.,Arrhythmia and Electrophysiology Department, Biocor Institute, Nova Lima, Brazil
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12
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Kylat RI, Samson RA. Permanent junctional reciprocating tachycardia in infants and Children. J Arrhythm 2019; 35:494-498. [PMID: 31293698 PMCID: PMC6595346 DOI: 10.1002/joa3.12193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/19/2019] [Indexed: 11/09/2022] Open
Abstract
Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate treatment is started early in the course, the failure can be ameliorated, and the cardiomyopathy can be resolved.
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Affiliation(s)
- Ranjit I. Kylat
- Department of PediatricsThe University of ArizonaCollege of MedicineTucsonArizona
| | - Ricardo A. Samson
- Chidren's Heart Center of NevadaLas VegasNevada
- Department of PediatricsLas Vegas School of MedicineUniversity of NevadaLas VegasNevada
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13
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Kaneko Y, Nakajima T, Nogami A, Inden Y, Asakawa T, Morishima I, Mizukami A, Iizuka T, Tamura S, Ota C, Kanzaki Y, Nakagawa K, Suzuki M, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Utilizing a Slow Pathway Extending to the Inferolateral Right Atrium. Circ Rep 2019; 1:46-54. [PMID: 33693113 PMCID: PMC7890287 DOI: 10.1253/circrep.cr-18-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background:
The existence of atypical fast-slow (F/S) atrioventricular (AV) nodal reentrant tachycardias (NRT) using slow pathway (SP) variants connected to the right atrial (RA) inferolateral (inf) free wall (FW) along the tricuspid annulus (TA), has been neither confirmed nor precisely characterized. Methods and Results:
We studied 7 patients (mean age, 48±16 years; 5 men) with F/S-AVNRT with long RP intervals and an earliest atrial activation at the RA inf-FW along the TA (inf-F/S-AVNRT). AV reentrant tachycardia was excluded on observation of the transition zone criteria in all 7 patients. Atrial tachycardia was excluded on the observation of a V-A-V activation sequence after the induction or entrainment of the tachycardia from the right ventricle in all. During the tachycardia, low-frequency, fractionated potentials (LP) preceding the local atrial electrogram were recorded near the site of the earliest atrial activation in 6 patients. Observations of conduction delay and block of the LP during ventricular entrainment or ablation of the tachycardia indicated that LP reflect retrograde activation via the inf-SP. Retrograde SP conduction was interrupted at the site of earliest atrial activation in 3 patients, and in the right posterior septum in 4 patients. Conclusions:
inf-F/S-AVNRT are distinct supraventricular tachycardia incorporating an SP variant connected to the RA inf-FW along the TA in the retrograde direction, which were eliminated by ablation.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Akihiko Nogami
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | | | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Chihiro Ota
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasunori Kanzaki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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14
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Clinical Features and Sites of Ablation for Patients With Incessant Supraventricular Tachycardia From Concealed Nodofascicular and Nodoventricular Tachycardias. JACC Clin Electrophysiol 2017; 3:1547-1556. [PMID: 29759837 DOI: 10.1016/j.jacep.2017.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/22/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to describe the clinical features and sites of successful ablation for incessant nodofascicular (NF) and nodoventricular (NV) tachycardias. BACKGROUND Incessant supraventricular tachycardias have been associated with tachycardia-induced cardiomyopathies and have been previously attributed to permanent junctional reciprocating tachycardias, atrial tachycardias, and atrioventricular nodal re-entrant tachycardias. Incessant concealed NF and NV tachycardias have not been described previously. METHODS Three cases of incessant concealed NF and NV re-entrant tachycardias were identified from 2 centers. RESULTS The authors describe 3 cases with incessant supraventricular tachycardia resulting from NV (2 cases) and NF (1 case) pathways. Atrioventricular nodal re-entrant tachycardia was excluded by His synchronous premature ventricular complexes that either delayed or terminated the tachycardia. Ventricular pacing showed constant and progressive fusion in cases 1 and 3. In 2 cases, there was spontaneous initiation with a 1:2 response (cases 1 and 3); the presence of retrograde longitudinal dissociation or marked decremental pathway conduction in cases 1 and 3 sustains these tachycardias. The NV pathway was successfully ablated in the slow pathway region in case 3 and at the right bundle branch in case 1. The NF pathway was successfully ablated within the proximal coronary sinus in case 2. CONCLUSIONS This is the first report of incessant supraventricular tachycardia using concealed NF or NV pathways. These tachycardias demonstrated spontaneous initiation from sinus rhythm with a 1:2 response and retrograde longitudinal dissociation or marked decremental pathway conduction. Successful ablation was achieved at either right-sided sites or within the coronary sinus.
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15
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Hill AC, Silka MJ, Wee CP, Bar-Cohen Y. Characteristics of Decremental Accessory Pathways in Children. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004190. [DOI: 10.1161/circep.116.004190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
Abstract
Background—
Although retrograde decremental accessory pathways (DAPs) are thought to typically present as permanent junctional reciprocating tachycardia (permanent junctional reciprocating tachycardia), they may also be diagnosed unexpectedly during electrophysiology study. We aimed to compare the clinical and electrophysiological characteristics of patients with DAPs to an age-matched cohort with nondecremental accessory pathways.
Methods and Results—
We retrospectively studied pediatric patients (<21 years of age) with retrograde DAPs and an age-matched control population with nondecremental accessory pathways who underwent electrophysiology study between 2005 and 2014. Decrement was defined as rate-dependent prolongation of the local ventriculo-atrial time by >30 ms. Twenty-six patients with DAPs were compared with 73 controls (mean age at electrophysiology study 9.8±5.7 and 10.3±5.2 years, respectively [
P
=nonsignificant]). Compared with controls, patients with DAPs had more frequent syncope (5/26 [19%] versus 3/73 [4%];
P
=0.02) and ventricular dysfunction (6/26 [23%] versus 4/73 [6%];
P
=0.04). Only 11 (42%) DAP patients manifested clinical permanent junctional reciprocating tachycardia, and these patients had more syncope (5/11 [45%] versus 0/15 [0%];
P
<0.01), slower orthodromic reciprocating tachycardia (176±44 beats per minute versus 229±31 beats per minute;
P
=0.001), and longer ventriculo-atrial times (mean maximum ventriculo-atrial times of 283±116 ms versus 208±42 ms;
P
=0.02) compared with those with DAPs without clinical permanent junctional reciprocating tachycardia. DAPs and controls had similar rates of acute ablation success (23/26 [89%] versus 67/73 [92%];
P
=nonsignificant) and recurrences (1/23 [4%] versus 2/67 [3%];
P
=nonsignificant).
Conclusions—
The majority of pediatric patients with DAPs do not present with clinical permanent junctional reciprocating tachycardia. DAPs are associated with more severe symptoms, but ablation outcomes are similar to those of age-matched controls.
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Affiliation(s)
- Allison C. Hill
- From the Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California (A.C.H., M.J.S., Y.B.-C.); and Biostatistics Core, Children’s Hospital, Los Angeles CA (C.P.W.)
| | - Michael J. Silka
- From the Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California (A.C.H., M.J.S., Y.B.-C.); and Biostatistics Core, Children’s Hospital, Los Angeles CA (C.P.W.)
| | - Choo Phei Wee
- From the Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California (A.C.H., M.J.S., Y.B.-C.); and Biostatistics Core, Children’s Hospital, Los Angeles CA (C.P.W.)
| | - Yaniv Bar-Cohen
- From the Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California (A.C.H., M.J.S., Y.B.-C.); and Biostatistics Core, Children’s Hospital, Los Angeles CA (C.P.W.)
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16
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Recurrence of permanent junctional re-entry tachycardia: Indication for ablation of the junctional pathway. Int J Cardiol 2016; 220:653. [PMID: 27393843 DOI: 10.1016/j.ijcard.2016.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/21/2016] [Indexed: 11/20/2022]
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17
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Kawamura M, Scheinman MM, Vedantham V, Marcus GM, Tseng ZH, Badhwar N. Clinical and Electrophysiological Characteristics of Incessant Atrioventricular Nodal Re-Entrant Tachycardia. JACC Clin Electrophysiol 2016; 2:596-602. [DOI: 10.1016/j.jacep.2016.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 11/16/2022]
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18
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[Permanent junctional reciprocating tachycardia causing cardiomyopathy in an adult woman]. Herzschrittmacherther Elektrophysiol 2016; 27:404-407. [PMID: 27605234 DOI: 10.1007/s00399-016-0453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
A 35-year-old female was referred with progressive dyspnoea and elevated heart rate. Surface electrocardiography (ECG) showed supraventricular tachycardia (SVT) with long RP interval and inverse P waves. ECG revealed left ventricular dilation and severe systolic dysfunction. An electrophysiological (EP) examination was performed due to incessant SVT despite betablocker medication. Permanent junctional reciprocating tachycardia (PJRT) was diagnosed and successfully ablated. During follow-up, the patient's symptoms abated and ECG parameters normalized. PJRT is usually found in infants and children, but should also be considered as a rare cause of incessant SVT and tachycardiomyopathy in adults.
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19
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Abed HS, Fulcher JR, Kilborn MJ, Keech AC. Inappropriate sinus tachycardia: focus on ivabradine. Intern Med J 2016; 46:875-83. [DOI: 10.1111/imj.13093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- H. S. Abed
- Department of Cardiology, Royal Prince Alfred Hospital and NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - J. R. Fulcher
- Department of Cardiology, Royal Prince Alfred Hospital and NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - M. J. Kilborn
- Department of Cardiology, Royal Prince Alfred Hospital and NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - A. C. Keech
- Department of Cardiology, Royal Prince Alfred Hospital and NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
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20
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Rodríguez-Mañero M, Fernández-López XA, González-Melchor L, García-Seara J, Martínez-Sande JL, González-Juanatey JR. Permanent junctional reciprocating tachycardia in a patient with an atypically located accessory pathway in the left lateral mitral annulus. Rev Port Cardiol 2016; 35:59.e1-5. [PMID: 26749575 DOI: 10.1016/j.repc.2015.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/01/2015] [Accepted: 07/01/2015] [Indexed: 11/16/2022] Open
Abstract
Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of atrioventricular reentrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction. The majority of accessory pathways in PJRT are located in the posteroseptal zone. Few cases of atypical location have been described. We report a case of PJRT in a 72-year-old woman in whom the accessory pathway was located in the left lateral region and treated by radiofrequency catheter ablation.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Arrhythmias Unit, Cardiology Department, University Hospital of Santiago de Compostela, Galicia, Spain.
| | - Xesús A Fernández-López
- Arrhythmias Unit, Cardiology Department, University Hospital of Santiago de Compostela, Galicia, Spain
| | - Laila González-Melchor
- Arrhythmias Unit, Cardiology Department, University Hospital of Santiago de Compostela, Galicia, Spain
| | - Javier García-Seara
- Arrhythmias Unit, Cardiology Department, University Hospital of Santiago de Compostela, Galicia, Spain
| | - Jose Luis Martínez-Sande
- Arrhythmias Unit, Cardiology Department, University Hospital of Santiago de Compostela, Galicia, Spain
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21
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Rodríguez-Mañero M, Fernández-López XA, González-Melchor L, García-Seara J, Martínez-Sande JL, González-Juanatey JR. Permanent junctional reciprocating tachycardia in a patient with an atypically located accessory pathway in the left lateral mitral annulus. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Yagishita A, Hachiya H, Higuchi K, Nakamura T, Sugiyama K, Tanaka Y, Sasano T, Kawabata M, Isobe M, Hirao K. Differentiation of atrial tachycardia from other long RP tachycardias by electrocardiographic characteristics. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Amara W, Monsel F. [Permanent junctional reciprocating tachycardia (Coumel type): a rare but curable form of tachycardia]. Ann Cardiol Angeiol (Paris) 2013; 62:361-3. [PMID: 24054446 DOI: 10.1016/j.ancard.2013.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/12/2013] [Indexed: 11/26/2022]
Abstract
We report the case of a 52 year-old man experiencing recurrent and incessant tachycardias despite antiarrhythmic drugs. Electrophysiological exploration confirmed the diagnosis of permanent junctional reentrant tachycardias (Coumel tachycardia). This tachycardia has been treated successfully by catheter ablation. The mechanisms of this tachycardias are explained.
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Affiliation(s)
- W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du G.L.-Leclerc, 93370 Montfermeil, France.
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24
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Abstract
Cardiac arrhythmias comprise of a heterogeneous group of disorders which manifest in a wide range of clinical presentations. They can be associated with underlying cardiac disease and portend a grave prognosis, with some arrhythmias being rapidly fatal. Other arrhythmias, however are relatively benign and can be asymptomatic or may be a mere inconvenience for the patient. All primary care physicians can expect to encounter some forms of arrhythmias during the course of their practice. This review article provides a brief overview of the commonly seen tachyarrhythmias for the general practitioner and provides relevant updates on the recent developments in our understanding of their mechanisms and management.
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Affiliation(s)
- Ramil Goel
- Department of Cardiovascular Disease, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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25
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Bonney WJ, Shah MJ. Incessant SVT in children: Ectopic atrial tachycardia and permanent junctional reciprocating tachycardia. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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SELVARAJ RAJA, ANANTHAKRISHNAPILLAI AJITH, SADASIVAM RAVISHANKAR, BALACHANDER JAYARAMAN. “Pseudo PJRT”-Fast-Slow AV Nodal Reentrant Tachycardia Presenting with Tachycardia-Induced Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 36:e4-6. [DOI: 10.1111/j.1540-8159.2011.03210.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 04/18/2011] [Accepted: 05/23/2011] [Indexed: 11/28/2022]
Affiliation(s)
- RAJA SELVARAJ
- From the Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry; India
| | | | - RAVISHANKAR SADASIVAM
- From the Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry; India
| | - JAYARAMAN BALACHANDER
- From the Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry; India
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27
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Abstract
PURPOSE OF REVIEW Supraventricular tachycardia (SVT) causing heart failure is an important cause of tachycardia-induced cardiomyopathy. RECENT FINDINGS Advances in anti-arrhythmic drugs to achieve either rate or rhythm control, curative ablative therapy directed at the underlying tachycardia mechanism to restore sinus rhythm, and atrioventricular junction ablation with permanent pacemaker placement for better rate control have improved the outcome of SVT management and subsequently improved the heart failure symptomatology and in some cases reversed remodeling of the cardiac dysfunction. SUMMARY The aim of this review is to provide the reader with clinical presentation as well as the common SVTs causing heart failure, pathophysiology of SVT causing heart failure, evaluation and management of SVT causing heart failure, and prognosis of SVT causing heart failure.
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28
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Lee KW, Badhwar N, Scheinman MM. Supraventricular Tachycardia—Part II: History, Presentation, Mechanism, and Treatment. Curr Probl Cardiol 2008; 33:557-622. [DOI: 10.1016/j.cpcardiol.2008.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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An unusual case of permanent junctional reciprocating tachycardia: Successful ablation at the mitral annulus-aorta junction. J Interv Card Electrophysiol 2008; 23:213-7. [PMID: 18810623 DOI: 10.1007/s10840-008-9299-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Abstract
A 25-year-old woman with drug-refractory permanent junctional reciprocating tachycardia (PJRT) and a previous failed ablation, was referred to our institution. Electrophysiological study confirmed the diagnosis of orthodromic atrioventricular reentry tachycardia using a slowly conducting accessory pathway. This accessory pathway was successfully ablated by conventional radiofrequency at the left anteroseptal region using a transseptal approach. Catheter ablation of this accessory pathway (Coumel type) at the mitral annulus-aorta junction offers insights on a rare anatomical location of PJRT.
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30
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Pap R, Traykov VB, Makai A, Bencsik G, Forster T, Sághy L. Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence. J Cardiovasc Electrophysiol 2008; 19:653-8. [PMID: 18284500 DOI: 10.1111/j.1540-8167.2008.01103.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left-sided approach. "Fragmented" or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. METHODS AND RESULTS Forty patients with posteroseptal or left posterior AP were included. The LA-CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A "fragmented" or double "atrial" potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right-sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. CONCLUSION During retrograde AP conduction, the sequence of LA-CS musculature activation-as deduced from analysis of electrograms recorded at the earliest site inside the CS-can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach.
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Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
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31
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Malcom J, Arnold O, Howlett JG, Ducharme A, Ezekowitz JA, Gardner MJ, Giannetti N, Haddad H, Heckman GA, Isaac D, Jong P, Liu P, Mann E, McKelvie RS, Moe GW, Svendsen AM, Tsuyuki RT, O'Halloran K, Ross HJ, Sequeira EJ, White M. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure--2008 update: best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies. Can J Cardiol 2008; 24:21-40. [PMID: 18209766 PMCID: PMC2631246 DOI: 10.1016/s0828-282x(08)70545-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/12/2007] [Indexed: 01/23/2023] Open
Abstract
Heart failure is a clinical syndrome that normally requires health care to be provided by both specialists and nonspecialists. This is advantageous because patients benefit from complementary skill sets and experience, but can present challenges in the development of a common, shared treatment plan. The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006, and on the prevention, management during intercurrent illness or acute decompensation, and use of biomarkers in January 2007. The present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006 and 2007, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence that was adopted and previously described by the Society. Specific recommendations and practical tips were written for best practices during the transition of care of heart failure patients, and the recognition, investigation and treatment of some specific cardiomyopathies. Specific clinical questions that are addressed include: What information should a referring physician provide for a specialist consultation? What instructions should a consultant provide to the referring physician? What processes should be in place to ensure that the expectations and needs of each physician are met? When a cardiomyopathy is suspected, how can it be recognized, how should it be investigated and diagnosed, how should it be treated, when should the patient be referred, and what special tests are available to assist in the diagnosis and treatment? The goals of the present update are to translate best evidence into practice, apply clinical wisdom where evidence for specific strategies is weaker, and aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.
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Affiliation(s)
- J Malcom
- University of Western Ontario, London, Canada.
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