This is the anterior view of the heart (drawn from a fluoro spot film) showing catheter position at the site of successful ablation in a 25-year-old medical student with >10 years' history of PSVT.
Within the year before the EP study, the patient developed almost daily episodes, and had failed digoxin, diltiazem, and verapamil.
During atrial decremental pacing at 500/350 msec (delta S1S2= -10 msec), a characteristic AH jump occurred from 350 to 490 msec. Regular slow-fast AVNRT at cl=330 with simultaneous VA activation, not reset by a PVC, was induced on minimal Isuprel and terminated with a spontaneous PAC.
A single RF application at the posteriormost extent of Koch's triangle ablated the slow pathway. Junctional tachycardia was observed during the ablation.
One sustained and several nonsustained PSVT episodes occurred within the following six months, after which the patient has been completely asymptomatic without repeat study.
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