Clinical course of persistent junctional reciprocating tachycardi

Objective The purpose of this study is to review the clinical course of persistent junctional reciprocating tachycardi (PJRT) in 21 patients spanning wide age range to examine the electrophysiologic characteristics of the conduction system in these patients with PJRT, particularly in regards to its incessant nature and to evaluate the long-term response to radiofrequency ablation. Background Persistent junctional reciprocating tachycardi is uncommon, occurring in 1% of patients with supraventricular tachycardia. Its presentation, course and treatment are incompletely characterized. Methods The clinical, electrocardiographic, electrophysiologic and echocardiographic dat of 21 patients with PJRT were reviewed. Results In 9 of these 21 patients, the mean tachycardi cycle length increased significantly (p < 0.0001) as the patients grew, from mean tachycardi cycle length of 308 ± 64 ms in the patients less than 2 years, 414 ± 57 ms in the patients between 2 years and 5 years, to 445 ± 57 ms in the patients greater than 5 years, primarily due to slowing of retrograde conduction in the accessory pathway. Persistent junctional reciprocating tachycardi was associated with impaired ventricular function in 11, improving spontaneously in 4 and, after successful ablation of the accessory pathway, in 7. All patients except one were uncontrolled on one or more medications. Ablation of the accessory pathway was successful in 19 of 21 patients. Conclusions We conclude that PJRT is characterized by an onset in early childhood and by an age-related prolongation of the tachycardi cycle length mediated primarily through conduction delay in the concealed, retrogradely conducting accessory pathway. Ablation of the accessory pathway provides definitive treatment for PJRT.