Speech-Triggered Neurogenic Cough Following Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia

Persistent cough following catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) is not a recognized complication. We report the case of an 81-year-old man who developed a persistent, speech-triggered dry cough beginning the day after successful slow pathway ablation. The cough was reproducibly provoked by phonation, absent during sleep, and persisted despite an unrevealing cardiopulmonary and inflammatory evaluation. To our knowledge, this phenotype has not been previously described following slow pathway ablation for AVNRT. Unlike post-ablation cough reported in left atrial and pulmonary vein procedures, where pulmonary, esophageal, phrenic, and autonomic mechanisms are well-characterized, slow pathway ablation targets the posteroseptal right atrium, a region not previously implicated in cough-related complications, making this a mechanistically distinct presentation. We propose a post-procedural neurogenic mechanism involving transient sensitization of vagal afferent pathways in the posteroseptal slow pathway region, consistent with a laryngeal hypersensitivity phenotype. Symptoms improved after colchicine, suggesting a limited inflammatory contribution to neural sensitization. This case expands the spectrum of potential complications after AVNRT ablation and may help guide recognition of atypical post-procedural symptoms while avoiding unnecessary diagnostic evaluation.