[The curative treatment of incessant atrioventricular tachycardia by radiofrequency ablation]

Abstract

The permanent form of junctional reciprocating tachycardia is due to accessory pathways with retrograde long conduction times. We report the localization of the atrial insertion of the accessory pathway and successful ablation with radiofrequency in 3 patients. The participation of an accessory pathway in the tachycardia was demonstrated by atrial capture without changes in the sequence, with ventricular stimuli during His bundle refractoriness. The atrial insertion was localized by mapping near the os of the coronary sinus. In all cases one to three radiofrequency pulses applied at this point interrupted the tachycardia. Retrograde conduction through the accessory pathway reappeared in 30 min or earlier in all, with displacement of the point of earliest atrial activation, and tachycardia recurred. Total abolition of accessory pathway conduction and cure of the tachycardia required new radiofrequency applications, that in one case were done in a second procedure.