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CLINICAL STUDIES

Clinical course of persistent junctional reciprocating tachycardia

Parvin C. Dorostkar, MD, FACC^a,b, Michael J. Silka, MD, FACC^a,b, Fred Morady, MD, FACC^a,b and Macdonald Dick, II, MD, FACC^a,b

^a Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA
^b Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
University-Arrhythmia Service, Departments of Pediatrics and Internal Medicine, Oregon Health Sciences University, Portland, Oregon; USA

Manuscript received June 11, 1997; revised manuscript received September 7, 1998, accepted October 22, 1998.

Reprint requests and correspondence: Dr. Macdonald Dick II, F1310 Box 0204, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan 48109-0204
mdick{at}umich.edu

Objective

The purpose of this study is to review the clinical course of persistent junctional reciprocating tachycardia (PJRT) in 21 patients spanning a 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 tachycardia 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 data of 21 patients with PJRT were reviewed.

Results

In 9 of these 21 patients, the mean tachycardia cycle length increased significantly (p < 0.0001) as the patients grew, from a mean tachycardia 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 tachycardia 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 tachycardia cycle length mediated primarily through conduction delay in the concealed, retrogradely conducting accessory pathway. Ablation of the accessory pathway provides definitive treatment for PJRT.

Abbreviations and Acronyms   ERP = effective refractory period   FRP = functional refractory period   PJRT = persistent junctional reciprocating tachycardia   RFA = radiofrequency ablation   V-A = ventriculo-atrial

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