Transcatheter ablative techniques for treatment of the permanent form of junctional reciprocating tachycardia in young patients.

Five patients with medically refractory incessant supraventricular tachycardia due to a posterior septal, slowly conducting accessory connection underwent transcatheter closed chest ablative treatment. The tachycardia characteristics were consistent with the permanent form of junctional reciprocating tachycardia. In each patient the ablative attempts resulted in independent interruption of either the anterograde limb (atrioventricular node-His bundle conduction) or the retrograde limb (accessory connection) of the tachycardia circuit. Permanent retrograde pathway ablation was achieved in only one patient and followed separate permanent transcatheter His bundle ablation. In three of the other four patients the ablation attempt caused temporary interruption of retrograde conduction. Each patient had improved control of tachycardia related to the ablation attempt. Of the five patients, four required pacemaker implantation. With further refinements, selective ablation of the retrograde limb of the tachycardia circuit may be possible. This experience confirms the anatomic independence of the anterograde and retrograde limbs of the tachycardia circuit.