Associazione Nazionale Medici Cardiologi Ospedalieri



Permanent junctional reciprocating tachycardia: it is important to know how to recognize it

testa sabrina chieti(ch) – ss annunziata | gallina sabina chieti(ch) – ss annunziata | renda giulia chieti(ch) – ss annunziata

Permanent junctional reciprocating tachycardia, also known as Coumel ‘s tachycardia, is a rare form of supraventricular tachycardia that is usually incessant, characterised by retrograde conduction via an accessory pathway usually located in the posteroseptal region with slow and decremental conduction. Tachycardia is virtually incessant, at a rate ranging from 120 to 250 beats/minute. The electrocardiogram inscribes inverted P waves in leads II, III, AVF, as well as left lateral leads, along with a P-R interval shorter than the R-P interval during the tachycardia. The characteristic, but not diagnostic, electrocardiographic feature is a long R-P interval consistent with slow retrograde conduction. Spontaneous resolution of tachycardia is not un common. Electrocardiographically, it manifests as a narrow QRS tachycardia with long RP ‘, with negative retrograde “p” waves in lower leads (D2, D3 and avF). The initiation and termination of the arrhythmia is not determined by a premature beat, but by critical changes in the RR cycle, that is, for values of the heart rate at which the activating front finds the retrograde decremental pathway outside refractoriness. Due to its incessant characteristic in some cases, patients may present tachycardiomyopathy, with myocardial dilation and ventricular dysfunction.

We report the case of a 5-year-old girl who came in for onset of heart palpitation for several hours. On electrocardiogram finding of supraventricular tachycardia, narrow QRS, HR 170/min, negative p waves in DII-DIII-AVF. The electrocardiographic finding was compatible with a picture of permanent junctional reciprocating tachycardia. Following the administration of 50mg of phleicanide, there is a progressive reduction in heart rate until the clinical picture stabilizes. antiarrhythmic therapy was subsequently set with subsequent re-evaluation and discharge to the patient ‘s home.