13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-157

Slow pathway in the treatment of junctional reciprocating tachycardia

Domenico Potenza, Ennio Pisano, Raimondo Massaro, Nicola Cianfrone, Raffaele Fanelli.
Department of Cardiology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S. Giovanni Rotondo, Italy

Introduction

The atrioventricular junctional reciprocating tachycardia (AVJRT) is one of the most common type of tachycardia seen in clinical practice (over 50% in some series). The syndrome is generally benign in patients without structural heart disease and the therapy serves to improve the quality of life. Chronic drug therapy is effective in reducing recurrences but is not curative¹. Atrioventricular (AV) node modification is a new technique safe and effective to treat the AVJRT in a curative way. In 1981 Sung showed that the dual capability of AV junction was not a property of the His bundle, as described until then^2,3, but of a large region located between the antero-septal space and the os of coronary sinus⁴. After several years the surgery was found to be effective to cure the AVJRT without impairment of AV conduction. After some experiences with the DC shock, radio frequency energy applied with a large tip of deflectable catheter was proposed to cure the AVJRT. The first attempts for AV node modification were performed in the antero-septal region⁶; the method was fast and effective, but with high percentage of total AV block. Finally the approach to the "slow pathway" was found to be effective and with a very low incidence of AV block^7,8.