Permanent junctional reciprocating tachycardia (PRJT) – a case report

A six-year-old girl with permanent junctional reciprocating tachycardia (PRJT) is presented. Tachycardia was observed in a respiratory infection during which the girl had no cardiac symptoms. PJRT is orthodromic AV re-entry permanent tachycardia with anterograde conduction via junction and retrograde slow conduction via accessory bundle most commonly located in the posterioseptal region. It is a rare type of permanent tachycardia which is usually diagnosed in childhood and in the long term can cause myocardiopathy. In our patient PJRT presented with a frequency of 150/min, deep negative P wave in II, III, aVF and V4-V6, prolonged RP interval – longer than the PR interval with no signs of cardiac insufficiency. In differential diagnosis atrial ectopic tachycardia with the source in posterior part of the septum and atypic fast-slow AV nodal re-entry (AVNRT) tachycardia were also considered. Diagnosis was based on ECG findings, normal heart ultrasound and 24-hour ECG monitoring where nearly permanent tachycardia was registered. For the diagnosis to be confirmed, electrophysiologic examination is necessary. Treatment of PJRT medicaly can sometimes be unsuccessful. Antiarrhythmics of IC and III group have the best therapeutic effect. In our patient, therapy with sotalol only reduced the frequency but did not stop tachycardia and therefore was changed. Propafenon was introduced with excellent results– the girl was in sinus rhythm even six months after commencing the therapy. Since the problem is longstanding, it is necessary to plan electrophysiologic examinations and possibly catheteric radioablation as today’s best and safest method of treatment of this tachyarrhythmia.
Category: Clinical observations - professional paper
Volume: Vol. 44, No 1,2 january - june 2000
Authors: V. Herceg-Čavrak, Ž. Cvetko
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