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[Permanent junctional reciprocating tachycardia: a little-known clinical entity curable with radiofrequency ablation]
A Menafoglio1, J Schläpfer, L Kappenberger
1Division de cardiologie, Centre hospitalier universitaire vaudois, Lausanne.
Abstract:
We report our experience of 5 patients with the permanent form of junctional reciprocating tachycardia (PJRT), a rare form of supraventricular arrhythmia. PJRT was discovered at a mean age of 31 years (8-60 years) and the mean duration of tachycardia was 13 years (1-40 years). 4 patients had nearly incessant tachycardia and one had paroxysmal attacks. Heart rate varied between 100 and 190 beats/minute and the minimal heart rate was on average 114 beats/minute. Four patients had palpitations, 2 developed tachycardia-induced cardiomyopathy, reversible after control of the arrhythmia, and 4 had asymptomatic episodes of PJRT. ECG showed in all cases a narrow-complex tachycardia with inverted P waves in inferior leads and RP interval greater than PR. All patients presented a posteroseptal accessory pathway. 4 patients received different antiarrhythmic drugs with only partially effective results. Radiofrequency catheter ablation of the accessory pathway was performed in all patients and was successful in 4, who remained free of recurrence after a mean follow-up of 26.5 months (4-37 months). The procedure was partially successful in the 5th patient, who is now asymptomatic under sotalol. Radiofrequency catheter ablation is therefore the treatment of choice of PJRT, a rare arrhythmia which should nevertheless be known in order to treat the patient correctly and avoid progression to cardiac failure, which is not always completely reversible.
Insights
Radiofrequency catheter ablation effectively treats permanent form of junctional reciprocating tachycardia (PJRT), a rare heart rhythm disorder. This procedure offers a high success rate, preventing recurrence and potential cardiac complications.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Context:
- Permanent form of junctional reciprocating tachycardia (PJRT) is a rare supraventricular arrhythmia.
- Patients diagnosed with PJRT typically present in adulthood with a long history of tachycardia.
- PJRT can lead to significant symptoms and potentially tachycardia-induced cardiomyopathy.
Purpose:
- To describe the clinical experience with PJRT in a cohort of 5 patients.
- To evaluate the efficacy of antiarrhythmic drugs and radiofrequency catheter ablation for PJRT.
- To highlight the importance of recognizing and appropriately treating PJRT to prevent cardiac failure.
Summary:
- Five patients with PJRT, a rare arrhythmia, were studied. Mean age at diagnosis was 31, with a mean tachycardia duration of 13 years.
- All patients had a posteroseptal accessory pathway. Antiarrhythmic drugs showed limited efficacy, while radiofrequency catheter ablation was successful in 4 out of 5 patients.
- Successful ablation led to freedom from recurrence in most patients, with one patient remaining asymptomatic on medication after partial success.
Impact:
- Radiofrequency catheter ablation is identified as the primary treatment for PJRT.
- Early diagnosis and effective treatment of PJRT can prevent the progression to potentially irreversible cardiac failure.
- This study underscores the need for awareness of PJRT among clinicians for timely and appropriate management.