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Catheter ablation induced reversal of chronic left ventricular dysfunction in permanent junctional tachycardia
N Saoudi1, G Kirkorian, G Atallah
1Hôpital Charles Nicolle, Rouen, France.
Insights
Catheter ablation effectively treats permanent junctional tachycardia, a heart rhythm disorder. This intervention can reverse associated heart failure and restore normal cardiac function, improving patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia.
- Patients often present with normal cardiac function at diagnosis.
- The underlying mechanism involves atrioventricular junctional reentry with a concealed posteroseptal accessory pathway.
Observation:
- Three patients with PJRT were studied.
- All patients initially had normal cardiac function.
- Over time, heart failure developed in all three patients.
Findings:
- Atrioventricular junctional reentry, utilizing a concealed posteroseptal accessory pathway, was identified as the cause of tachycardia.
- One patient underwent His bundle ablation and pacemaker insertion due to heart failure.
- Two patients received catheter ablation targeting the accessory pathway.
- All patients demonstrated reversal of left ventricular abnormalities post-intervention, confirmed by imaging.
- One patient experienced normalization of ejection fraction within 3 months after treatment.
Implications:
- Catheter ablation is an effective treatment for PJRT.
- Intervention can successfully suppress the arrhythmia and reverse associated rhythmic cardiomyopathy.
- Early and effective treatment can prevent or reverse cardiac dysfunction in PJRT patients.
Abstract:
Three patients with the permanent form of junctional tachycardia are reported. All had a normal cardiac function when the rhythm disorder was discovered. The basis for tachycardia in the three cases was atrioventricular junctional reentry whose retrograde limb was a concealed posteroseptal accessory pathway. Because of the development of heart failure over the years, one patient had His bundle ablation combined with pacemaker insertion, and the others underwent catheter ablation of the accessory pathway. Reversal of left ventricular involvement, as assessed by chest X ray and echocardiography was noted in every patient. Ejection fraction in one patient, measured by radionuclide angiography, returned to normal 3 months later. Thus catheter ablation of permanent junctional tachycardia can effectively suppress rhythmic cardiomyopathy.