Key result
Radiofrequency ablation of a right posteroseptal accessory pathway caused a slow junctional rhythm followed by transient AV block, which resolved spontaneously after 48 hours.
Case Report (n=1)
No
This case demonstrates that even a slow junctional rhythm during RF ablation of a posteroseptal accessory pathway can be a harbinger of transient AV block, likely due to edema.
Answers are grounded in this paper and cite their sources.
Slow junctional rhythm may herald transient AV block during posteroseptal pathway ablation; hypothesis-generating case leaves monitoring implications open.
MOREIRA, J.M., et al.: Slow Junctional Rhythm During Catheter Ablation of Right Posteroseptal Accessory Pathway Causing Transient Atrioventricular Block. A male patient with palpitations and syncope during an episode of atrial fibrillation was evaluated. After DC cardioversion, the ECG showed a pattern of pre‐excitation compatible with right posteroseptal bypass tract. The patient was submitted to RF. During energy application a slow junctional rhythm without AV block was noted. Twenty‐four hours after the procedure AV block was observed. The AV conduction was resumed spontaneously 48 hours later with unremarkable outcome up to 1 year. We postulated that the edema caused by RF application damaged the compact AV node, causing transient AV block. The AV node lesion has been manifested by a fast junctional rhythm, but in this case we observed that even a slow junctional rhythm could do it. (PACE; 26:770–772)
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Moreira et al. (2003) conducted a case report in Right posteroseptal accessory pathway with pre-excitation (n=1). Radiofrequency (RF) catheter ablation was evaluated on Transient atrioventricular (AV) block. Radiofrequency ablation of a right posteroseptal accessory pathway caused a slow junctional rhythm followed by transient AV block, which resolved spontaneously after 48 hours.
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