Atypical location of Coumel Tachycardia in Adult: Case Report

Authors

  • Raoni de Castro Galvão Centro de Ritmologia de Brasília – Brasília (DF), Brazil. https://orcid.org/0000-0001-5541-2684
  • João Paulo Velasco Pucci Centro de Ritmologia de Brasília – Brasília (DF), Brazil.
  • Ofir Gomes Vieira Centro de Ritmologia de Brasília – Brasília (DF), Brazil.

Keywords:

Catheter ablation, Reciprocating tachycardia, Supraventricular tachycardia

Abstract

Coumel Tachycardia or Incessant Junctional Reentrant (IJRT) generally affects the infant-juvenile population and is characterized by tachycardia due to atrioventricular reentry (AV) mediated by an exclusive, slow, decremental retrograde conduction pathway mostly located in the posterosseptal region of the tricuspid ring. Case report: The present study reported the case of an adult, 49 years old, with IJRT of atypical location. The patient reported feeling palpitations for 5 years with worsening in the last 6 months. After one of his seizures, an electrocardiogram (ECG) documented tachycardia due to AV reentry with a long RP ‘interval. Subjected to an electrophysiological study, an accessory pathway of exclusive retrograde conduction with decreasing characteristics was observed, located in the right mid-septal region. There was easy induction of IJRT, remaining sustained throughout the study. A radiofrequency ablation was performed in the mid-septal D region with interruption of tachycardia, with no more atrioventricular retrograde conduction, the procedure ended without complications. Discussion: Interestingly, the case described differs both in terms of the age range of the most frequent involvement of the IJRT (children and young people), as well as the most common location of the accessory pathway (posterior and postero-septal region of the tricuspid ring). Ablation proved to be effective in this case and is the treatment of choice for IJRT despite the anomalous location of the accessory pathway (Middle-septal D: described in bibliographic reviews in only 7% of IJRT cases) and a potentially dangerous region due to proximity to the trunk of the His beam.

Downloads

Download data is not yet available.

References

Coumel P, Cabrol C, Fabiato A et al. Tachycardie permanente par rythme re´ciproque. Preuves du diagnostic par stimulation auriculaire et ventriculaire. Arch Mal Coeur 1967;60:1830–1864.

Coumel P. Junctional reciprocating tachycardias. The permanent and paroxysmal forms of A–V nodal reciprocating tachycardias. J Electrocardiol 1975;8:79–90.

Critelli G, Gallagher JJ, Thiene G et al. The permanent form of junctional reciprocating tachycardia. In: Benditt DG, Benson DW, eds. Cardiac Preexcitation Syndromes. Boston: Martinus Nijhoff; 1986. pp 233–253.

Meiltz A, Weber R, Halimi F et al. Permanent form of junctional reciprocating tachycardia in adults: peculiar features and results of radiofrequency catheter ablation. Europace (2006) 8, 21–28 doi:10.1093/europace/euj007

Critelli G. Recognizing and managing permanent junctional reciprocating tachycardia in the catheter ablation era. J Cardiovasc Electrophysiol 1997;8:226–236.

Ticho BS, Saul JP, Hulse JE et al. Variable location of accessory pathways associated with the permanent form of junctional reciprocating tachycardia and confirmation with radiofrequency ablation. Am J Cardiol 1992;70:1559–1564.

Dorostkar PC, Silka MJ, Morady F et al. Clinical course of persistent junctional reciprocating tachycardia. J Am Coll Cardiol 1999;33:366–375.

Packer DL, Bardy GH, Worley SJ et al. Tachycardia-induced cardiopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 1986; 57:563–570.

Downloads

Published

2020-11-06

How to Cite

de Castro Galvão, R., Velasco Pucci, J. P., & Gomes Vieira, O. (2020). Atypical location of Coumel Tachycardia in Adult: Case Report. JOURNAL OF CARDIAC ARRHYTHMIAS, 33(3), 170–175. Retrieved from https://jca.emnuvens.com.br/jca/article/view/3398

Issue

Section

Electrophysiology

Categories