Recurrence of Permanent Junctional Re-entry Tachycardia: Indication for Ablation of the Junctional Pathway

Echocardiography showed a severe dilatation of the left ventricle of 6.8 cm and a severe reduction of left ventricular function with an ejection fraction of 28%. Furthermore, moderate mitral and tricuspid regurgitation was documented.After two days resuming of the prior dosage of bisoprolol, the patient still was in incessant permanent junctional re-entry tachycardia, which lead to dramatic deterioration of left ventricular function. This patient was send home and was booked for radiofrequency ablation in an electrophysiological laboratory not far away.

PJRT is a potentially lethal arrhythmia in children and in adolescants with tachycardia induced cardiomyopathy. Although rarely reported, spontaneous resolution is not uncommon. Antiarrhythmic treatment is often effective,especially with amiodarone and verapamil. Radiofrequency ablation should be reserved for older patients and especially in patients with persistent left ventricular dysfunction.Radiofrequency ablation of this particular accessory pathway remains an intervention at high risk of requiring permanent pacemaker implantation because of its proximity to the septum. The primary ablation success rate is 92%, but the recurrence rate after 9 months is 29% for cryoablation and 8.6% for radiofrequency ablation. Read more.............