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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

View larger version (13K): [in a new window]   Figure 1 Twelve lead electrocardiogram demonstrating typical PJRT in a 12 year old girl. Note the negative P waves in leads II, III, AVF, and the lateral precordial leads. The P-R interval is shorter than the R-P interval.

View larger version (15K): [in a new window]   Figure 2 The PJRT cycle length, measured from serial electrocardiograms, is plotted against age in 9 patients presenting during the first 2 years of life. Two serial electrocardiograms were available in 3 patients, three in 1 patient, six in 1 patient, seven in 1 patient, nine in 1 patient, twenty-one in 1 patient and twenty-seven in 1 patient. The data under 2 years of age were obtained from 4 of the 9 patients. To examine for a trend in the data, the curvilinear line in this figure and in Figures 3 and 4 was created by subjecting the data to a nonparametric smoothing technique (Systat, Inc, Aurora, Colorado). Note the gradual increase in cycle length with increasing age. The patients were on no medications for the initial electrocardiogram; later in their course, digoxin, flecainide and propranolol were used predominantly, with no effect on the tachycardia. No measurements were made in the 2 patients during amiodarone therapy. Although drug effect cannot be fully excluded from the serial observations depicted in this figure as well as in Figures 3 and 4, it is unlikely that marked effects occurred given the persistence of the arrhythmia and the uneven use of and inconsistent compliance with the antiarrhythmic agents.

View larger version (13K): [in a new window]   Figure 3 The R-P interval, measured from serial electrocardiograms, is plotted against age in 9 patients presenting during the first 2 years of life. The R-P interval is plotted serially for each subject. The curve describes the trend in the R-P interval at points during childhood and adolescence. Note the increase in R-P interval with increasing age in patients with PJRT, and the similarity of this increase with that of the PJRT cycle length, suggesting that the slowing of conduction retrograde in the accessory pathway accounts, for the most part, for the prolongation of the PJRT cycle length.

View larger version (13K): [in a new window]   Figure 4 The P-R interval, measured from serial electrocardiograms, is plotted against age in 9 patients presenting during the first 2 years of life. The P-R interval is plotted serially for each subject. The curve describes the trend in the P-R interval at points during childhood and adolescence. In contrast to the R-P interval in these patients, there is only the expected age related increase in the P-R interval over the first 15 years of life.