Copyright © 1998 by the European Society of Cardiology.
Permanent junctional re-entry tachycardia. A multicentre long-term follow-up study in infants, children and young adults
a Department of Pediatric Cardiology, University Children’s Hospital, Homburg/Saar, Germany
b Department of Cardiology of the University, Homburg/Saar, Germany
c Department of Pediatric Cardiology, University Children’s Hospital, Aachen, Germany
d Department of Pediatric Cardiology, University Children’s Hospital, Hannover, Germany
e Department of Pediatric Cardiology, University Children’s Hospital, Heidelberg, Germany
f Department of Pediatric Cardiology, University Children’s Hospital, Rostock, Germany
g Department of Cardiology, W.G. Kerckhoff-Clinic, Bad Nauheim, Germany
h Department of Cardiology, AK St. Georg, Hamburg, Germany
accepted November 21, 1997
Aims
Permanent junctional re-entry tachycardia is a relatively uncommon form of re-entry tachycardia with antegrade conduction occurring through the atrioventricular node and retrograde conduction over an accessory pathway usually located in the postero-septal region. It was the aim of the study to investigate the course of permanent junctional re-entry tachycardia with particular regard to the effectiveness of pharmacological treatment and ablation procedures; evaluation was performed with respect to the patient’s symptoms, tachycardia rate, frequency of the tachycardia and left ventricular function.
Methods and Results
The long-term follow-up of 32 patients with permanent junctional re-entry tachycardia was evaluated. The first presentation with supraventricular tachycardia occurred between the 27th week of gestation and 27 years. The tachycardia rate ranged from 100 to 250 beats.min–1. During Holter-ECG, permanent junctional re-entry tachycardia was documented as present for over 50% of the time in 24h in 22 patients (69%). Left ventricular performance was impaired in nine patients (28%) due to a tachycardia-related cardiomyopathy. Symptoms or signs of heart failure were mild to moderate in eight and severe in four patients; 20 patients showed no clinical impairment. Follow-up time was 1 to 31 (mean 10) years; current age of the patients ranged from 1·5 months to 35 (mean=15·3) years. Four patients needed no therapy because of the infrequency of permanent junctional re-entry tachycardia episodes. Twenty-five patients initially received antiarrhythmic drugs, which were effective or partially effective in 14 (56%). Eight of them are still on medical therapy; in five treatment was discontinued because of absence of symptoms. Eleven patients had ablation of the accessory pathway during follow-up, three underwent ablation as a primary procedure.
Conclusion
Permanent junctional re-entry tachycardia in our experience is an arrhythmia with a large variety of clinical symptoms. Patients with a slow tachycardia rate and infrequent episodes of tachycardia may never develop symptoms and therefore do not need any therapy. Patients with frequent permanent junctional re-entry tachycardia, a fast tachycardia rate and impaired left ventricular function need effective therapy. In infancy and early childhood medical therapy is recommended as a first option, whereas in older and symptomatic patients catheter ablation is an effective and safe procedure.
Key Words: permanent junctional re-entry tachycardia • catheter ablation • PJRT long-term follow-up • childhood/adolescence
f1 Correspondence: Angelika Lindinger, MD, Department of Pediatric Cardiology, University Children’s Hospital, D-66421 Homburg/Saar, Germany.
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