Self-conversion of drug-resistant paroxysmal atrial tachycardia.

A 56-year-old woman had paroxysmal atrial tachycardia (PAT) that was recurrent, drug-resistant and required frequent electroversion. The mode of onset and termination of initiated episodes of PAT suggested an AV junctional reentrant mechanism. The problem was successfully managed by a permanent electrode implanted transvenously in the coronary sinus and connected to a subcutaneous radio frequency receiver. For the past 24 months the patient has successfully terminated all episodes of PAT (at least 60) by activating an external radio frequency transmitter that transmits impulses to the implanted receiver and electrode catheter. Conversion to sinus rhythm requires 5 seconds or less of pacing.