[Successful selective electrical ablation of the retrograde pathway in atrioventricular nodal reentry tachycardia...

A 55-year-old man was admitted to the intensive care unit on account of repeatedly occurring syncopes which developed at the peak of physical exertion. The attack was reproduced by exercise on a bicycle ergometer: the patient developed paroxysmal tachycardia with a narrow QRS and a frequency of 160/min leading after 20 sec. to severe hypotension and loss of consciousness. The same tachycardia caused by programmed atrial stimulation caused a drop of tension in the recumbent position by 30 mmHg and after more detailed analysis during electrophysiological examination it was evaluated as atrioventricular nodal reentrant tachycardia. By an electric discharge of 300 J administered by means of a stimulation electrode 7F USCI into the area of the AV node the retrograde conduction through the perinodal rapid pathways was completely interrupted and 1st. degree atrioventricular block developed. Repeated electrophysiological examination and exercise tests on a bicycle ergometer provided evidence of the disappearance of the retrograde pathway and the impossibility to elicit AVNRT. The authors express the view that the rapid perinodal pathway is interrupted in successful cases in both directions and the 1st. degree AV block is due to conduction along a slow pathway and not incidental slowing of conduction along the rapid pathway which is the generally accepted interpretation. Modification of the atrioventricular conduction by interruption of the rapid pathway by fulguration is according to data in the literature and the described patient a method which makes is possible to cure severe atrioventricular nodal reentrant tachycardias.