AV-nodal reentrant tachycardia as a potential trigger for atrial fibrillation: a case report
█ Case report
Jánosi Kristóf-Ferenc, Debreceni Dorottya, Simor Tamás, Kupó Péter
Pécsi Tudományegyetem, Klinikai Központ, Szívgyógyászati Klinika, Pécs
Dr. Jánosi Kristóf-Ferenc, Pécsi Tudományegyetem, Klinikai Központ, Szívgyógyászati Klinika, 7624 Pécs, Ifjúság útja 13.
In patients with atrial fibrillation (AF), the gold standard ablation procedure is the complete electrical isolation of the pulmonary veins (PVs). However, in certain cases the initial arrhythmia is induced by non-pulmonary vein triggers (e.g. ligament of Marshall, posterior wall of the left atrium, superior vena cava, supraventricular tachycardias).
We present a case of a 35-year-old female patient without comorbidities who was repeatedly observed in the emergency department due to AF. She was referred to our institution for considering pulmonary vein isolation (PVI). Based on her medical history, a diagnostic electrophysiology study (EPS) was performed prior to the planned PVI. During the EPS, AV nodal reentry tachycardia (AVNRT) was repeatedly inducible which has converted into AF two times before terminated spontaneously. Slow pathway ablation was performed, AF was considered as a secondary arrhythmia triggered by the AVNRT, therefore PVI was cancelled. During the 9 month-follow-up, no arrythmia recurrence was detected. Considering the patients’ medical history, EPS can be performed before PVI procedures in selected patients with AF, to unmask supraventricular tachycardias as non-pulmonary vein triggers.